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.<\/p>\n
In this Case Study Assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.<\/p>\n
To Prepare<\/strong><\/h2>\n![\"NURS](\"https:\/\/nursingassignmentcrackers.com\/wp-content\/uploads\/2023\/03\/NURS-6512-Assignment-3-Digital-Clinical-Experience-Comprehensive-Head-to-Toe-Physical-Assessment-IN-300x141.png\")
NURS 6512 Assignment 3 Digital Clinical Experience Comprehensive (Head-to-Toe) Physical Assessment IN<\/figcaption><\/figure>\n\n- By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the \u201cCourse Announcements\u201d section of the classroom for your assignment from your Instructor.<\/li>\n
- Also, your Case Study Assignment should be in the Episodic\/Focused SOAP Note format rather than the traditional narrative style 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.<\/li>\n<\/ul>\n
With regard to the case study you were assigned:<\/p>\n
\n- Review this week’s Learning Resources, and consider the insights they provide about the case study.<\/li>\n
- Consider what history would be necessary to collect from the patient in the case study you were assigned.<\/li>\n
- 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?<\/li>\n
- Identify\u00a0at least five<\/strong>\u00a0possible conditions that may be considered in a differential diagnosis for the patient.<\/li>\n<\/ul>\n
The Case Study Assignment<\/strong><\/h2>\nUse the Episodic\/Focused SOAP Template and create 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.<\/p>\n
By Day 6 of Week 9<\/strong><\/h2>\nSubmit<\/strong> your Assignment.<\/p>\nSubmission and Grading Information<\/strong><\/h3>\nTo submit your completed Assignment for review and grading, do the following:<\/strong><\/h3>\n\n- Please save your Assignment using the naming convention \u201cWK9Assgn1+last name+first initial.(extension)\u201d as the name.<\/li>\n
- Click the\u00a0Week 9 Assignment 1 Rubric\u00a0<\/strong>to review the Grading Criteria for the Assignment.<\/li>\n
- Click the\u00a0Week 9 Assignment 1 <\/strong>link. You will also be able to \u201cView Rubric\u201d for grading criteria from this area.<\/li>\n
- Next, from the Attach File area, click on the\u00a0Browse My Computer<\/strong>\u00a0button. Find the document you saved as \u201cWK9Assgn1+last name+first initial.(extension)\u201d and click\u00a0Open<\/strong>.<\/li>\n
- If applicable: From the Plagiarism Tools area, click the checkbox for\u00a0I agree to submit my paper(s) to the Global Reference Database<\/strong>.<\/li>\n
- Click on the\u00a0Submit<\/strong>\u00a0button to complete your submission.<\/li>\n<\/ul>\n
Grading Criteria<\/strong><\/h2>\nTo access your rubric:<\/u><\/p>\n
Week 9 Assignment 1 Rubric<\/u><\/p>\n
<\/p>\n
Check Your Assignment Draft for Authenticity<\/strong><\/h2>\nTo check your Assignment draft for authenticity:<\/u><\/p>\n
Submit your Week 9 Assignment 1 draft and review the originality report.<\/u><\/p>\n
<\/p>\n
Submit Your Assignment by Day 6 of Week 9<\/strong><\/h2>\nTo participate in this Assignment:<\/u><\/p>\n
Week 9 Assignment 1<\/u><\/p>\n
<\/p>\n
Assignment 2: Lab Assignment: Practice Assessment: Neurological Examination<\/strong><\/h2>\nShort of opening a patient’s cranium or requesting a brain scan, what can an advanced practice nurse do to determine the cause of neurological symptoms? A multitude of techniques can be used to generate a neurological diagnosis.<\/p>\n
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due this week, it is recommended that you practice performing a neurological examination.<\/p>\n
Note:<\/em><\/strong>\u00a0This is a\u00a0practice physical assessment.<\/em><\/p>\nTo Prepare<\/strong><\/h2>\n\n- Arrange an appropriate time and setting with a volunteer “patient” to perform a neurological examination.<\/li>\n
- Download and review the Neurological Checklist provided in this week’s Learning Resources as well as review Seidel’s Guide to Physical Examination<\/em> online media.<\/li>\n<\/ul>\n
The Lab Assignment<\/strong><\/h2>\nComplete the following in Shadow Health:<\/p>\n
\n- Neurological (Practice)<\/li>\n<\/ul>\n
Assignment 3: Digital Clinical Experience: Comprehensive (Head-to-Toe) Physical Assessment <\/strong><\/h2>\nThroughout\u00a0this course, you were encouraged to practice conducting various physical assessments on multiple areas of the body, ranging from the head to the toes. Each of these assessments, however, was conducted independently of one another. For this DCE Assignment, you connect the knowledge and skills you gained from each individual assessment to perform a comprehensive head-to-toe physical examination in your Digital Clinical Experience.<\/p>\n
Photo Credit: Getty Images\/Hero Images<\/p>\n
To Prepare<\/strong><\/h2>\n\n- Review this week\u2019s Learning Resources, and download and review the Physical Examination Objective Data Checklist as well as the Student Checklists and Key Points documents related to neurologic system and mental status.<\/li>\n
- Review the Shadow Health Resources provided in this week\u2019s Learning Resources specifically the tutorial to guide you through the documentation and interpretation with the Shadow Health platform. Review the examples also provided.<\/li>\n
- Review the DCE (Shadow Health) Documentation Template for Comprehensive (Head-to-Toe) Physical Assessment found in this week\u2019s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.<\/li>\n
- Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.<\/li>\n
- Review the Week 9 DCE Comprehensive Physical Assessment Rubric provided in the Assignment submission area for details on completing the Assessment in Shadow Health.<\/li>\n
- Also, your Week 9 Assignment 3 should be in the Complete SOAP Note format. Refer to Chapter 2 of the Sullivan text and the Week 4 Complete Physical Exam template and use the template below for your submission.<\/li>\n<\/ul>\n
Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6512 Assignment 3 Digital Clinical Experience Comprehensive (Head-to-Toe) Physical Assessment IN<\/strong><\/a><\/span><\/h3>\nA Sample Answer For the Assignment: NURS 6512 Assignment 3 Digital Clinical Experience Comprehensive (Head-to-Toe) Physical Assessment IN<\/strong><\/h2>\nTitle: <\/strong> NURS 6512 Assignment 3 Digital Clinical Experience Comprehensive (Head-to-Toe) Physical Assessment IN<\/strong><\/h2>\nPatient Information:<\/strong><\/h2>\nInitials: H.F.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Age: 47 Years\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sex: Female\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Race: Caucasian<\/p>\n
S.<\/u><\/strong><\/p>\nCC<\/strong> (chief complaint): \u201cI am experiencing pain in my right wrist\u201d<\/p>\nHPI<\/strong>: H.F., a 47-year-old Caucasian female with obesity, sought medical attention at the clinic due to her primary concern of experiencing pain in her right wrist, accompanied by sensations of numbness and tingling in the index, middle finger, and thumb. The patient has provided an account of experiencing these symptoms approximately fourteen days prior. Nevertheless, she expresses apprehension regarding the discomfort, as it causes her to inadvertently release her hairstyling implements.<\/p>\nLocation: Right wrist<\/p>\n
Onset: two weeks ago<\/p>\n
Character: Numbness and pain in her right wrist<\/p>\n
Associated signs and symptoms: Thumb, middle, and index finger tingling<\/p>\n
Timing: the whole day<\/p>\n
Exacerbating\/ relieving factors: Worse while doing tasks with the wrist joint. When the wrist is stationary, the discomfort is reduced.<\/p>\n
Severity: 6\/10<\/p>\n
Current Medications<\/strong>:<\/h2>\n\n- Ibuprofen at a dosage of 400mg taken orally as needed,<\/li>\n
- Hydrochlorothiazide at a dosage of 25mg taken orally every morning<\/li>\n
- Amlodipine at a dosage of 10mg taken orally once daily.<\/li>\n<\/ul>\n
Allergies: <\/strong>Allergic to sulfur. No\u00a0environmental or food allergies.<\/p>\nPMHx<\/strong>: The patient exhibits obesity and has a documented history of hypertension.<\/p>\n\n- Immunization status: The patient has received all necessary vaccinations, including Tdap in October 2020, the Influenza Vaccine during the current season, and completed the COVID-19 Vaccines with Boosters in 2021.<\/li>\n
- Surgeries: without any prior surgical history<\/li>\n
- Hospitalization: There is no record of any hospitalizations.<\/li>\n<\/ul>\n
Soc Hx<\/strong>: The patient is a hairdresser who works five blocks from her house in a neighborhood spa. She claims to have a history of sometimes consuming alcohol while smoking cigarettes. She does not, however, admit to using marijuana or any other illegal substance. She presently lives as a family with her husband and three kids. During her free time, she enjoys singing and reading. She exercises by taking the dog for a 30-minute walk every evening. She affirms that she eats a healthy diet and sleeps well for around 8 hours each night.<\/p>\nFam Hx<\/strong>: The patient has two siblings, the younger of whom has just received an asthma\u00a0diagnosis while the other is well. Both of her parents are still living; the mother has a history of T2DM and HTN, while the father has a history of HTN and esophagostomy. She is unaware of the medical history of her grandparents.<\/p>\nROS<\/strong>:<\/p>\nGENERAL: denies any symptoms of heat or cold sensitivity, reduced appetite, sluggishness, chills, fever, or recent weight changes.<\/p>\n
HEENT: Head: denies experiencing seizures, headaches, or dizziness. Eye: denies any discomfort, discharge, vision disturbances, photophobia, or blurriness. Ear: denies\u00a0discharge, tinnitus, discomfort, or hearing loss. Nose: denies having sneeze fits, sinus pain, a runny nose, or nose bleeding. Throat: denies pain, swallowing issues, or voice hoarseness.<\/p>\n
SKIN: denies rash or itching.<\/p>\n
CARDIOVASCULAR: denies having orthopnea, arrhythmias, elevated blood pressure, or palpitations.<\/p>\n
RESPIRATORY: denies having a cough, producing phlegm, having breathing problems, or breathing quickly.<\/p>\n
GASTROINTESTINAL: denies experiencing vomiting, heartburn, heartburn pain, discomfort, or abdominal distention.<\/p>\n
GENITOURINARY: denies having hematuria, vaginal discharge, incontinence, dysuria, oliguria, frequent urination, or burning pain.<\/p>\n
NEUROLOGICAL: denies experiencing ataxia, a headache, paralysis, syncope, or abnormalities in bowel or bladder control. reports tingling and numbness in the middle, index, and thumb fingers.<\/p>\n
MUSCULOSKELETAL: a right wrist ache is reported. denies muscular pain, joint stiffness, or joint swelling. demonstrates the complete range of motion in other joints.<\/p>\n
HEMATOLOGIC: denies bleeding issues, easy bruising, or anemia.<\/p>\n
LYMPHATICS: denies splenectomy or lymphadenopathy.<\/p>\n
PSYCHIATRIC: denies experiencing hallucinations or other psychological symptoms such as anxiety, sadness, or thoughts of homicide or suicide.<\/p>\n
ENDOCRINOLOGIC: denies a tendency to sweat excessively, polyuria, polydipsia, or sensitivity to heat and cold.<\/p>\n
ALLERGIES: Sulfur allergy is reported.<\/p>\n
O.<\/u><\/strong><\/p>\nPhysical exam<\/strong>: Vital signs<\/strong>: BP- 138\/86 mmHg, PR-86, RR-19, Temp- 98.9, SpO2-98% on room air, Ht- 5\u20199\u201d, Wt- 210 lbs., BMI-31.01<\/p>\nGENERAL: a female who is obese and adequately attired. Clear speaking, the patient is focused and aware X4. The patient\u00a0responds to inquiries adequately and is not visibly distressed.<\/p>\n
HEENT: Head: normal-sized, trauma-free, and without scars. Eye: Sclera and conjunctiva are clear. No significant redness, discharge, or tearing. Ear: Typical pinna with an unobstructed tympanic membrane. It is normal for the external auditory canal. Nose: nasal mucous membrane that is wet. No sinuses or discomfort to the touch. Throat: pink, wet mucous membrane in the mouth. The tonsils and posterior pharynx are not erythematous, and the uvula is in the middle.<\/p>\n
MUSCULOSKELETAL: Gait and musculoskeletal development are normal. displays a healthy body posture without any joint or bone swelling or abnormalities. Right thumb abduction shows weakness, with a 3\/5 poor strength. Positive Hoffmann-Tinel and Phalen indicators. All the muscles of the other limb are strong and their tendon reflexes are normal.<\/p>\n
NEUROLOGICAL: Aware and well-grounded in time, location, and people. quite helpful throughout the assessment. All of the cranial nerves are mostly unharmed. demonstrates typical reactions. The right hand’s middle finger, thumb, and index finger all feel numb and tingly.<\/p>\n
Diagnostic results<\/strong>: The complete blood count (CBC) reveals a white blood cell count (WBC) of 8.9. Additionally, a comprehensive metabolic panel (CMP) including differentials is performed.\u00a0 The glucose level is measured at 125, while the HgbA1c level is recorded as 4.5%, indicating the need to exclude any potential presence or occurrence. Neuropathy associated with type 2 diabetes mellitus (T2DM). The concentration of C-reactive protein in the sample is 4.2 mg\/L (Attal & Didier Bouhassira, 2023).<\/p>\nDiagnostic Tests:<\/strong><\/h2>\n\n- An X-ray examination of the right wrist was conducted to assess the presence of arthritic changes (Genova et al., 2020).<\/li>\n
- Test for bone density to rule out osteoporosis.<\/li>\n
- nerve conduction analysis.<\/li>\n
- Manual: Tinel sign and Durkans Test (Zhang et al., 2020).<\/li>\n<\/ul>\n
A<\/u><\/strong>.<\/u><\/p>\nDifferential Diagnoses:<\/strong><\/h2>\n\n- Carpal tunnel syndrome (CTS): This condition is characterized by symptoms such as tingling and numbness in the fingers, which occur due to compression of the median nerve within the carpal tunnel (Malakootian et al., 2022). This condition is commonly regarded as an occupational disease characterized by repetitive wrist and finger extension and flexion. However, certain cases of CTS may have an unknown cause, and the risk of developing CTS can be influenced by various factors, including genetic and acquired factors. A nerve conduction study is a precise diagnostic tool used to identify both normal and abnormal values of nerve function. Diagnostic laboratory results can also be utilized for the identification of increased levels of inflammatory markers. The patient exhibits multiple risk factors for developing this disease, including occupational factors and obesity.<\/li>\n
- Peripheral neuropathy: This condition\u00a0is linked to hand numbness. The patient’s gender, familial history, and weight contribute to their increased risk of developing type 2 diabetes mellitus (T2DM) (Selvarajah et al., 2019). Peripheral neuropathy is a frequently observed symptom associated with T2DM, characterized by a gradual onset. A two-point discrimination test was conducted, revealing decreased sensitivity in the patient’s right arm. The patient reports no decrease in sensation in the lower extremities. If the patient experiences altered symptoms and exhibits new-onset neuropathy in the lower extremities, I will contemplate reevaluating the A1C levels and potentially diagnose diabetic peripheral neuropathy based on diagnostic assessments. Diabetic individuals exhibit significant declines in hand and finger dexterity relative to their healthy counterparts.<\/li>\n
- Wartenberg\u2019s syndrome: This condition\u00a0presents as paresthesia or pain occurring along the radial aspect of the forearm, with symptoms radiating toward\u00a0the thumb and middle fingers. The pain arises due to the compression of the superficial radial nerve. Potential external factors may include the presence of a wristwatch or objects exerting pressure on the nerve (Kuschner & Berihun, 2021). The technique of palpation in the vicinity of the radial nerve region is employed to detect potential masses located both superficially and deeply. The utilization of the Tinel’s sign aids in the confirmation of this particular diagnosis.<\/li>\n
- Lupus: This\u00a0is an autoimmune disease characterized by immune system dysfunction, resulting in inflammation, a high body temperature, joint pain, malaise, and rash. DNA methylation is a specific and reliable biomarker for the diagnosis of lupus, exhibiting cell-type specificity (Fanouriakis et al., 2020). DNA methylation is more prominent in patients with active disease compared to those in remission. The lupus band test (LBT) is a direct immunofluorescent approach conducted through skin biopsy. It is particularly valuable in cases where clinical and laboratory data are inconclusive for diagnosing lupus.<\/li>\n
- Type 2 Diabetes Mellitus (T2DM): The patient is at a heightened risk of developing T2DM. In the event of a gradual increase in the patient’s HbA1c, it is recommended to implement a prediabetes protocol involving lifestyle modifications such as dietary changes, exercise, and regular monitoring of HbA1c levels. Diabetic peripheral neuropathy (DNP) is characterized by progressive metabolic and inflammatory alterations that result in impaired daily functioning and reduced independence (Wu et al., 2021). Fasting lipid levels should be included in laboratory tests to assess cholesterol levels and provide education on cholesterol, triglycerides, LDL, and HDL levels.<\/li>\n<\/ol>\n
\u00a0<\/strong><\/p>\n\u00a0<\/strong><\/p>\nReferences<\/strong><\/h2>\nAttal, N., & Didier Bouhassira. (2023).\u00a0Neuropathic Pain<\/em>. https:\/\/doi.org\/10.1093\/med\/9780197616345.001.0001<\/a><\/p>\nFanouriakis, A., Tziolos, N., Bertsias, G., & Boumpas, D. T. (2020). Update \u039fn the Diagnosis and Management of Systemic Lupus Erythematosus.\u00a0Annals of the Rheumatic Diseases<\/em>,\u00a080<\/em>(1), annrheumdis-2020-218272. https:\/\/doi.org\/10.1136\/annrheumdis-2020-218272<\/a><\/p>\nGenova, A., Dix, O., Saefan, A., Thakur, M., & Hassan, A. (2020). Carpal Tunnel Syndrome: A Review of Literature.\u00a0Cureus<\/em>,\u00a012<\/em>(3). https:\/\/doi.org\/10.7759\/cureus.7333<\/a><\/p>\nKuschner, S. H., & Berihun, H. (2021). Robert Wartenberg Syndrome and Sign: A Review Article.\u00a0The Open Orthopaedics Journal<\/em>,\u00a015<\/em>(1), 13\u201316. https:\/\/doi.org\/10.2174\/1874325002115010013<\/a><\/p>\nMalakootian, M., Soveizi, M., Gholipour, A., & Oveisee, M. (2022). Pathophysiology, Diagnosis, Treatment, and Genetics of Carpal Tunnel Syndrome: A Review.\u00a0Cellular and Molecular Neurobiology<\/em>. https:\/\/doi.org\/10.1007\/s10571-022-01297-2<\/a><\/p>\nSelvarajah, D., Kar, D., Khunti, K., Davies, M. J., Scott, A. R., Walker, J., & Tesfaye, S. (2019). Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention.\u00a0The Lancet Diabetes & Endocrinology<\/em>,\u00a07<\/em>(12), 938\u2013948. https:\/\/doi.org\/10.1016\/s2213-8587(19)30081-6<\/a><\/p>\nWu, B., Niu, Z., & Hu, F. (2021). Study on Risk Factors of Peripheral Neuropathy in Type 2 Diabetes Mellitus and Establishment of Prediction Model.\u00a0Diabetes & Metabolism Journal<\/em>,\u00a045<\/em>(4), 526\u2013538. https:\/\/doi.org\/10.4093\/dmj.2020.0100<\/a><\/p>\nZhang, D., Chruscielski, C., Blazar, P., & Earp, B. (2020). Accuracy of Provocative Tests for Carpal Tunnel Syndrome.\u00a0Journal of Hand Surgery Global Online<\/em>,\u00a02<\/em>(3), 121\u2013125. https:\/\/doi.org\/10.1016\/j.jhsg.2020.03.002<\/a><\/p>\nA Sample Answer 2 For the Assignment: NURS 6512 Assignment 3 Digital Clinical Experience Comprehensive (Head-to-Toe) Physical Assessment IN<\/strong><\/h2>\nTitle: <\/strong> NURS 6512 Assignment 3 Digital Clinical Experience Comprehensive (Head-to-Toe) Physical Assessment IN<\/strong><\/h2>\n\u00a0<\/strong><\/p>\nOBJECTIVE DATA<\/strong><\/h3>\n<\/h3>\n
Vital signs:<\/strong> Respiration- 15<\/p>\nTemp- 37.2 C<\/p>\n
Heartrate – 78<\/p>\n
SpO2- 99%<\/p>\n
\n- Height: 170 cm<\/li>\n
- Weight: 84 kg<\/li>\n
- BMI: 29.0<\/li>\n
- Blood Glucose: 100<\/li>\n
- RR: 15<\/li>\n
- HR: 78<\/li>\n
- BP:128 \/ 82<\/li>\n
- Pulse Ox: 99%<\/li>\n
- Temperature: 99.0 F<\/li>\n<\/ul>\n
General:<\/strong> Jones is alert oriented, seated upright on examination table, and is in no distress. She is well-nourished, developed, and dressed appropriately with good hygiene.<\/p>\nHEENT: <\/strong>Head is normocephalic, atraumatic. Eyes bilateral with equal hair distribution on lashes and eyebrows. No lesions on lids, no edema or ptosis. Pink conjunctiva, white sclera, PERRLA bilaterally, intact extraocular eye movements, and no nystagmus. Mild retinopathic changes on right. Left fundus with sharp disc margins, no hemorrhages. Snellen: 20\/20 right eye, 20\/20 left eye with corrective lenses. TMs intact and pearly gray bilaterally, positive light reflex. Whispered words heard bilaterally. Frontal and maxillary sinuses nontender to palpation. Nasal mucosa moist and pink, septum midline. Oral mucosa moist without ulcerations or lesions, uvula rises midline on phonation. Gag reflex intact. Dentition without evidence of caries or infection.<\/p>\nNeck: <\/strong>Thyroid smooth without nodules, no goiter. No lymphadenopathy.<\/p>\nChest\/Lungs: <\/strong>Lung sounds clear and voice is present in all areas. Spanish symmetrically. Chest anterior and posterior normal upon inspection. fremitus equal bilaterally. Chest is symmetric with respiration, clear to auscultation bilaterally without cough or wheeze. Resonant to percussion throughout. In office spirometry: FVC 3.91 L, FEV1\/FVC ratio 80.56%.<\/p>\nHeart\/Peripheral Vascular: <\/strong>Pirated 2 + with no thrill or bruit bilaterally. PMI non-discplaced. S1 and S2 only regular rhythm. No bruit in aorta or any other arteries. Capillary refill is less than 3 seconds in fingers and toes no edema is present. Heart rate is regular, S1, S2, without murmurs, gallops, or rubs. Bilateral carotids equal bilaterally without bruit. PMI at the midclavicular line, 5th intercostal space, no heaves, lifts, or thrills. Bilateral peripheral pulses equal bilaterally, capillary refill less than 3 seconds. No peripheral edema.<\/p>\nAbdomen: <\/strong>bowel sounds are normal in all quadrants. moves bowels regularly. Abdomen is soft with no Masses. liver is one centimeter below the right costal margin. Quadrants are tympanic and spleen is Not dull in sound. Kidney is not palpable no masses are present<\/p>\n <\/p>\n
Abdomen protuberant, symmetric, no visible masses, scars, or lesions, coarse hair from pubis to umbilicus. Bowel sounds are normoactive in all four quadrants. Tympanic throughout to percussion. No tenderness or guarding to palpation. No organomegaly. No CVA tenderness.<\/p>\n
Genital\/Rectal: <\/strong>–<\/h2>\nMusculoskeletal: <\/strong>Range of motion in all areas of full or muscle strength or 5 out of 5 no CVA tenderness. DTR 2+. Strength 5\/5 bilateral upper and lower extremities, without swelling, masses, or deformity and with full range of motion. No pain with movement.<\/p>\n\u00a0<\/strong><\/p>\nNeurological: <\/strong>for the feet especially left foot area. Patient is able to sense position of body fingers and toes. Graphesthesia normal sense. Patient is oriented to time person and place. Heel to Shin normal. Normal graphesthesia, stereognosis, and rapid alternating movements bilaterally. Tests of cerebellar function normal. DTRs 2+ and equal bilaterally in upper and lower extremities. Decreased sensation to monofilament in bilateral plantar surfaces.<\/p>\nSkin: <\/strong>Acne is present on the face. Skin is normal. Norwegians or abnormalities in the nails. Old scar is present on the left shin.<\/p>\nScattered pustules on face and facial hair on upper lip, acanthosis nigricans on posterior neck. Nails free of ridges or abnormalities.<\/p>\n
\u00a0<\/strong><\/p>\nDiagnostic results: <\/strong>None<\/h2>\n\u00a0<\/strong><\/p>\nASSESSMENT: <\/strong>Jones is a 28-year-old female that has come today for her pre-employment assessment. She appears well dressed and responsive. She is diabetic and asthmatic, which are controlled. She uses corrective lenses. She has normal sleeping cycle. She engages in active physical activity and has dietary modifications for diabetes control. She monitors her blood glucose levels on a daily basis. She also monitors her peak flow to track asthma and uses albuterol inhaler to manage its symptoms. She denies any current acute health problems. \u00a0<\/strong><\/p>\n\u00a0<\/strong><\/p>\nPLAN: <\/strong>This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.<\/em><\/p>\nS.<\/u><\/strong><\/h3>\nCC<\/strong>: \u201cI have a headache around my forehead.\u201d<\/p>\nHPI<\/strong>: J.K.L is a 40-year-old African American female who presents with a complaint of a headache across her forehead for a week. The headache is squeezing and feels like pressure behind the eyes. It is non-radiating. The headache is constant and varies in severity ranging from 2\/10 at its best to 8\/10 at its worst. It is usually worse in the morning and while bending. Acetaminophen reduces the severity of the headache to 4\/10 and occasionally 2\/10. It is associated with fever, postnasal drip, nasal congestion, sneezing, and occasional non-productive cough. She takes Sudafed HCL 120 mg every 12 hours to obtain some relief. The symptoms have significantly impaired her concentration at work and made her feel very tired. Finally, she reports a head cold three weeks ago.<\/p>\nCurrent Medications<\/strong>: Pseudoephedrine 120 mg BID for nasal congestion and acetaminophen for headaches.<\/p>\nAllergies: <\/strong>She has no known food and drug allergies.<\/p>\nPast Medical History<\/strong>: During her last visit to the primary care physician 2 months ago, she was noted to be prehypertensive and was advised on lifestyle modifications. No prior hospitalization. No previous surgeries or blood transfusions.<\/p>\nSocial History<\/strong>: She is married with two children both alive and well. She works as a secretary Her husband is a college teacher. She neither drinks alcohol nor smokes tobacco. She does not use marijuana or other illicit drugs. She strictly adheres to dietary advice from her nutritionist and she exercises regularly. Denies caffeine intake.<\/p>\nFamily History<\/strong>: Father alive aged 60 years and with hypertension while her mother is 58 years old alive and well. Her brother and sister are 35 and 20 years old respectively, alive and well. Her paternal grandfather died at the age of 80 years due to a heart attack while her paternal grandmother is 78 years and is hypertensive. Her maternal grandfather is 77 years with a history of type 2 diabetes and high cholesterol while her maternal grandmother died at the age of 70 years due to a stroke. No family history of malignancies, mental illness, asthma, sickle cell, or diabetes.<\/p>\nROS<\/strong>:<\/h2>\nGENERAL: Reports fatigue and occasional fever. Denies weight loss, night sweats, and chills.<\/p>\n
HEENT: \u00a0Reports headaches, nasal congestion, post nasal drip, and sneezing. No blurring of vision, visual loss, hearing loss, tinnitus, nose bleeds, ear pain, mouth sores, or sore throat.<\/p>\n
SKIN: \u00a0no skin lesion or rashes. No abnormal pigmentation.<\/p>\n
CARDIOVASCULAR: Negative for palpitations, chest pain, paroxysmal nocturnal dyspnea, and peripheral limb edema.<\/p>\n
RESPIRATORY: \u00a0Occasional non-productive cough. No difficulty in breathing, dyspnea, or orthopnea.<\/p>\n
GASTROINTESTINAL: Reports loss of appetite and occasional nausea and vomiting. Denies change in bowel habits, abdominal pain, or distention.<\/p>\n
GENITOURINARY:\u00a0No frequency, dysuria, nocturia, and polyuria. No vaginal itchiness or abnormal vaginal discharge.<\/p>\n
NEUROLOGICAL: Reports headache. Denies dizziness, lightheadedness, numbness, tingling, loss of sensation, syncope, and convulsion.<\/p>\n
MUSCULOSKELETAL: No muscle pain, joint pains, muscle weakness, or muscle swelling.<\/p>\n
HEMATOLOGIC: \u00a0No anemia, easy bruising, or bleeding.<\/p>\n
LYMPHATICS: Normal lymph nodes<\/p>\n
PSYCHIATRIC: \u00a0Denies anxiety, depression, suicidal ideations, or hallucinations.<\/p>\n
ENDOCRINOLOGIC: Denies heat or cold intolerance, polyphagia, and polydipsia.<\/p>\n
ALLERGIES: \u00a0Reports no allergies.<\/p>\n
O.<\/u><\/strong><\/h3>\nPhysical exam<\/strong>:<\/h2>\nVITAL SIGNS: BP 125\/78 mmHg, HR 88 b\/min, Temp 99. 8 F, RR 20 b\/min, saturation 95% on room air, Height 168 cm, weight 76 Kg. Pain level 5\/10<\/p>\n
GENERAL: A middle-aged African-American female, well kempt, not in any form of respiratory distress but slight discomfort. Maintains eye contact, coherent speech, and a stable mood. Well-hydrated and nourished. No palmar or conjunctival pallor, jaundice, central or peripheral cyanosis, cervical or inguinal lymphadenopathy, and peripheral limb edema.<\/p>\n
HEENT: Normocephalic and atraumatic head. Non-tender scalp. Bilateral eyes with pink conjunctiva and white sclera. Pupils equally and bilaterally reacting to light, no ptosis or lid edema. Normal extraocular movements. Bilateral ears present, no impaction or skin lesions, tympanic membrane pearly grey bilaterally, and positive white reflex. Both nares are present and are discharging mucus, midline nasal septum, and pink and soft nasal mucosa. Tender maxillary and frontal sinus. Moist and pink oral mucosa, no oral lesions or ulceration. Normal dentition and teeth alignment.<\/p>\n
NECK: Soft neck. The trachea is central. Full range of motion, non-tender, no cervical lymphadenopathy, and no thyroid enlargement.<\/p>\n
CARDIOVASCULAR: Regular heart rate. Normoactive precordium. Point of maximal impulse in the 5th<\/sup> intercostal space in the midclavicular line. S1 and S2 head, no murmurs, thrills, gallops, rubs, or heaves.<\/p>\nRESPIRATORY: Symmetrical chest that moves with respiration. No scars or skin lesions. Equal chest expansion and equal tactile fremitus bilaterally. Equal air entry, vesicular breath sounds, no wheezes, and crackles, and equal vocal fremitus in all lung zones.<\/p>\n
NEUROLOGICAL: GCS 15\/15, oriented to time, place, and person, intact short-term and long-term memory, good concentration, and a clear coherent speech. Cranial nerves 1 to 12 intact. Normotonic across all joints, normal bulk, and power 5\/5 across all muscle groups in upper and lower extremities, deep tendon reflexes 2+ and equal bilaterally in upper and lower limbs. Intact monofilament sensation across all dermatomes, good bowel, and bladder function. No spinal tenderness, normal gait, coordination, graphesthesia, and stereognosis. Normal finger nose, heel to the shin, and rapid alternating movements tests.<\/p>\n
Diagnostic results<\/strong>:<\/h2>\nJ.K.L appears to have an inflammatory\/infectious condition. Consequently, complete blood count and inflammatory markers particularly CRP and ESR are paramount. Similarly, bacterial or fungal cultures obtained endoscopically or by direct sinus aspiration are required to identify the possible pathogen. Additionally, a skin prick test is essential to exclude allergic rhinitis. Imaging modalities principally Sinus CT and MRI are recommended to evaluate for rhinosinusitis and intraorbital or intracranial involvement.<\/p>\n
<\/p>\n
A<\/u><\/strong>.<\/u><\/h3>\nDifferential Diagnoses<\/strong><\/h2>\nAcute Sinusitis- <\/strong>refers to the inflammation of sinuses lasting less than 4 weeks (DeBoer & Kwon, 2022). The condition is more common in females and particularly during early fall to early spring (DeBoer & Kwon, 2022). It is most commonly caused by viral infection following a common cold although bacteria and fungi are not uncommon etiologies. J.K.L presents with clinical features that are typical of acute sinusitis including fatigue, fever, headache, facial pain, and pressure worse on bending (DeBoer & Kwon, 2022). Maxillary sinuses and frontal sinuses appear to be the affected sinuses in her as evidenced by pain around the forehead and tenderness of the maxillary and frontal sinuses (DeBoer & Kwon, 2022).<\/p>\nRhinitis- <\/strong>Refers to the inflammation of the nasal mucosa. J.K.L presents with clinical manifestations suggestive of rhinitis including sneezing, nasal congestion, postnasal drip, and rhinorrhea (Liva et al., 2021). Similarly, she reports a \u201chead cold\u201d three weeks ago. Rhinitis is mostly caused by an upper respiratory infection or type 1 hypersensitivity reaction (Liva et al., 2021). However, an upper respiratory tract infection is likely the cause in her case.<\/p>\nCluster headache- <\/strong>Cluster headache is a type of primary headache that is usually unilateral retro-orbital and characterized by sharp and stabbing pain (Goadsby et al., 2018). Cluster headache may present with symptoms of lacrimation, nasal congestion, rhinorrhea, ptosis, or miosis (Goadsby et al., 2018). However, it is unlikely the diagnosis in her as cluster headache usually lasts for a brief period. Similarly, cluster headaches mostly awake the patient at night.<\/p>\nMigraine headache- <\/strong>Migraine headache is another type of primary headache that may be preceded with or without aura. It is usually pulsating and moderate to severe (Pescador Ruschel & O, 2022). It is common in young women. However, it is unlikely the diagnosis as migraines last 4 to 72 hours if untreated and are typically associated with nausea, vomiting, photophobia, and phonophobia (Pescador Ruschel & O, 2022).<\/p>\nRebound headache<\/strong>– Commonly referred to as medication overuse headache. Rebound headache predominantly occurs in individuals with primary headaches who overuse analgesia (Micieli & Robblee, 2018). Rebound headaches are more common in females and individuals less than 50 years. Drugs precipitating this headache include barbiturates, acetaminophen, opioids, ergotamine, and triptans (Micieli & Robblee, 2018). However, this is an unlikely diagnosis in J.K.L as a diagnosis of primary headache hasn\u2019t been established.<\/p>\n <\/p>\n
References<\/strong><\/h2>\nDeBoer, D. L., & Kwon, E. (2022).\u00a0Acute Sinusitis<\/em>. https:\/\/pubmed.ncbi.nlm.nih.gov\/31613481\/<\/a><\/p>\nGoadsby, P., Wei, D.-T., & Yuan Ong, J. (2018). Cluster headache: Epidemiology, pathophysiology, clinical features, and diagnosis.\u00a0Annals of Indian Academy of Neurology<\/em>,\u00a021<\/em>(5), 3. https:\/\/doi.org\/10.4103\/aian.aian_349_17<\/a><\/p>\nLiva, G. A., Karatzanis, A. D., & Prokopakis, E. P. (2021). Review of rhinitis: Classification, types, pathophysiology.\u00a0Journal of Clinical Medicine<\/em>,\u00a010<\/em>(14), 3183.
- \n
- By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the \u201cCourse Announcements\u201d section of the classroom for your assignment from your Instructor.<\/li>\n
- Also, your Case Study Assignment should be in the Episodic\/Focused SOAP Note format rather than the traditional narrative style 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.<\/li>\n<\/ul>\n
With regard to the case study you were assigned:<\/p>\n
- \n
- Review this week’s Learning Resources, and consider the insights they provide about the case study.<\/li>\n
- Consider what history would be necessary to collect from the patient in the case study you were assigned.<\/li>\n
- 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?<\/li>\n
- Identify\u00a0at least five<\/strong>\u00a0possible conditions that may be considered in a differential diagnosis for the patient.<\/li>\n<\/ul>\n
The Case Study Assignment<\/strong><\/h2>\n
Use the Episodic\/Focused SOAP Template and create 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.<\/p>\n
By Day 6 of Week 9<\/strong><\/h2>\n
Submit<\/strong> your Assignment.<\/p>\n
Submission and Grading Information<\/strong><\/h3>\n
To submit your completed Assignment for review and grading, do the following:<\/strong><\/h3>\n
- \n
- Please save your Assignment using the naming convention \u201cWK9Assgn1+last name+first initial.(extension)\u201d as the name.<\/li>\n
- Click the\u00a0Week 9 Assignment 1 Rubric\u00a0<\/strong>to review the Grading Criteria for the Assignment.<\/li>\n
- Click the\u00a0Week 9 Assignment 1 <\/strong>link. You will also be able to \u201cView Rubric\u201d for grading criteria from this area.<\/li>\n
- Next, from the Attach File area, click on the\u00a0Browse My Computer<\/strong>\u00a0button. Find the document you saved as \u201cWK9Assgn1+last name+first initial.(extension)\u201d and click\u00a0Open<\/strong>.<\/li>\n
- If applicable: From the Plagiarism Tools area, click the checkbox for\u00a0I agree to submit my paper(s) to the Global Reference Database<\/strong>.<\/li>\n
- Click on the\u00a0Submit<\/strong>\u00a0button to complete your submission.<\/li>\n<\/ul>\n
Grading Criteria<\/strong><\/h2>\n
To access your rubric:<\/u><\/p>\n
Week 9 Assignment 1 Rubric<\/u><\/p>\n
<\/p>\n
Check Your Assignment Draft for Authenticity<\/strong><\/h2>\n
To check your Assignment draft for authenticity:<\/u><\/p>\n
Submit your Week 9 Assignment 1 draft and review the originality report.<\/u><\/p>\n
<\/p>\n
Submit Your Assignment by Day 6 of Week 9<\/strong><\/h2>\n
To participate in this Assignment:<\/u><\/p>\n
Week 9 Assignment 1<\/u><\/p>\n
<\/p>\n
Assignment 2: Lab Assignment: Practice Assessment: Neurological Examination<\/strong><\/h2>\n
Short of opening a patient’s cranium or requesting a brain scan, what can an advanced practice nurse do to determine the cause of neurological symptoms? A multitude of techniques can be used to generate a neurological diagnosis.<\/p>\n
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due this week, it is recommended that you practice performing a neurological examination.<\/p>\n
Note:<\/em><\/strong>\u00a0This is a\u00a0practice physical assessment.<\/em><\/p>\n
To Prepare<\/strong><\/h2>\n
- \n
- Arrange an appropriate time and setting with a volunteer “patient” to perform a neurological examination.<\/li>\n
- Download and review the Neurological Checklist provided in this week’s Learning Resources as well as review Seidel’s Guide to Physical Examination<\/em> online media.<\/li>\n<\/ul>\n
The Lab Assignment<\/strong><\/h2>\n
Complete the following in Shadow Health:<\/p>\n
- \n
- Neurological (Practice)<\/li>\n<\/ul>\n
Assignment 3: Digital Clinical Experience: Comprehensive (Head-to-Toe) Physical Assessment <\/strong><\/h2>\n
Throughout\u00a0this course, you were encouraged to practice conducting various physical assessments on multiple areas of the body, ranging from the head to the toes. Each of these assessments, however, was conducted independently of one another. For this DCE Assignment, you connect the knowledge and skills you gained from each individual assessment to perform a comprehensive head-to-toe physical examination in your Digital Clinical Experience.<\/p>\n
Photo Credit: Getty Images\/Hero Images<\/p>\n
To Prepare<\/strong><\/h2>\n
- \n
- Review this week\u2019s Learning Resources, and download and review the Physical Examination Objective Data Checklist as well as the Student Checklists and Key Points documents related to neurologic system and mental status.<\/li>\n
- Review the Shadow Health Resources provided in this week\u2019s Learning Resources specifically the tutorial to guide you through the documentation and interpretation with the Shadow Health platform. Review the examples also provided.<\/li>\n
- Review the DCE (Shadow Health) Documentation Template for Comprehensive (Head-to-Toe) Physical Assessment found in this week\u2019s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.<\/li>\n
- Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.<\/li>\n
- Review the Week 9 DCE Comprehensive Physical Assessment Rubric provided in the Assignment submission area for details on completing the Assessment in Shadow Health.<\/li>\n
- Also, your Week 9 Assignment 3 should be in the Complete SOAP Note format. Refer to Chapter 2 of the Sullivan text and the Week 4 Complete Physical Exam template and use the template below for your submission.<\/li>\n<\/ul>\n
Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6512 Assignment 3 Digital Clinical Experience Comprehensive (Head-to-Toe) Physical Assessment IN<\/strong><\/a><\/span><\/h3>\n
A Sample Answer For the Assignment: NURS 6512 Assignment 3 Digital Clinical Experience Comprehensive (Head-to-Toe) Physical Assessment IN<\/strong><\/h2>\n
Title: <\/strong> NURS 6512 Assignment 3 Digital Clinical Experience Comprehensive (Head-to-Toe) Physical Assessment IN<\/strong><\/h2>\n
Patient Information:<\/strong><\/h2>\n
Initials: H.F.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Age: 47 Years\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sex: Female\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Race: Caucasian<\/p>\n
S.<\/u><\/strong><\/p>\n
CC<\/strong> (chief complaint): \u201cI am experiencing pain in my right wrist\u201d<\/p>\n
HPI<\/strong>: H.F., a 47-year-old Caucasian female with obesity, sought medical attention at the clinic due to her primary concern of experiencing pain in her right wrist, accompanied by sensations of numbness and tingling in the index, middle finger, and thumb. The patient has provided an account of experiencing these symptoms approximately fourteen days prior. Nevertheless, she expresses apprehension regarding the discomfort, as it causes her to inadvertently release her hairstyling implements.<\/p>\n
Location: Right wrist<\/p>\n
Onset: two weeks ago<\/p>\n
Character: Numbness and pain in her right wrist<\/p>\n
Associated signs and symptoms: Thumb, middle, and index finger tingling<\/p>\n
Timing: the whole day<\/p>\n
Exacerbating\/ relieving factors: Worse while doing tasks with the wrist joint. When the wrist is stationary, the discomfort is reduced.<\/p>\n
Severity: 6\/10<\/p>\n
Current Medications<\/strong>:<\/h2>\n
- \n
- Ibuprofen at a dosage of 400mg taken orally as needed,<\/li>\n
- Hydrochlorothiazide at a dosage of 25mg taken orally every morning<\/li>\n
- Amlodipine at a dosage of 10mg taken orally once daily.<\/li>\n<\/ul>\n
Allergies: <\/strong>Allergic to sulfur. No\u00a0environmental or food allergies.<\/p>\n
PMHx<\/strong>: The patient exhibits obesity and has a documented history of hypertension.<\/p>\n
- \n
- Immunization status: The patient has received all necessary vaccinations, including Tdap in October 2020, the Influenza Vaccine during the current season, and completed the COVID-19 Vaccines with Boosters in 2021.<\/li>\n
- Surgeries: without any prior surgical history<\/li>\n
- Hospitalization: There is no record of any hospitalizations.<\/li>\n<\/ul>\n
Soc Hx<\/strong>: The patient is a hairdresser who works five blocks from her house in a neighborhood spa. She claims to have a history of sometimes consuming alcohol while smoking cigarettes. She does not, however, admit to using marijuana or any other illegal substance. She presently lives as a family with her husband and three kids. During her free time, she enjoys singing and reading. She exercises by taking the dog for a 30-minute walk every evening. She affirms that she eats a healthy diet and sleeps well for around 8 hours each night.<\/p>\n
Fam Hx<\/strong>: The patient has two siblings, the younger of whom has just received an asthma\u00a0diagnosis while the other is well. Both of her parents are still living; the mother has a history of T2DM and HTN, while the father has a history of HTN and esophagostomy. She is unaware of the medical history of her grandparents.<\/p>\n
ROS<\/strong>:<\/p>\n
GENERAL: denies any symptoms of heat or cold sensitivity, reduced appetite, sluggishness, chills, fever, or recent weight changes.<\/p>\n
HEENT: Head: denies experiencing seizures, headaches, or dizziness. Eye: denies any discomfort, discharge, vision disturbances, photophobia, or blurriness. Ear: denies\u00a0discharge, tinnitus, discomfort, or hearing loss. Nose: denies having sneeze fits, sinus pain, a runny nose, or nose bleeding. Throat: denies pain, swallowing issues, or voice hoarseness.<\/p>\n
SKIN: denies rash or itching.<\/p>\n
CARDIOVASCULAR: denies having orthopnea, arrhythmias, elevated blood pressure, or palpitations.<\/p>\n
RESPIRATORY: denies having a cough, producing phlegm, having breathing problems, or breathing quickly.<\/p>\n
GASTROINTESTINAL: denies experiencing vomiting, heartburn, heartburn pain, discomfort, or abdominal distention.<\/p>\n
GENITOURINARY: denies having hematuria, vaginal discharge, incontinence, dysuria, oliguria, frequent urination, or burning pain.<\/p>\n
NEUROLOGICAL: denies experiencing ataxia, a headache, paralysis, syncope, or abnormalities in bowel or bladder control. reports tingling and numbness in the middle, index, and thumb fingers.<\/p>\n
MUSCULOSKELETAL: a right wrist ache is reported. denies muscular pain, joint stiffness, or joint swelling. demonstrates the complete range of motion in other joints.<\/p>\n
HEMATOLOGIC: denies bleeding issues, easy bruising, or anemia.<\/p>\n
LYMPHATICS: denies splenectomy or lymphadenopathy.<\/p>\n
PSYCHIATRIC: denies experiencing hallucinations or other psychological symptoms such as anxiety, sadness, or thoughts of homicide or suicide.<\/p>\n
ENDOCRINOLOGIC: denies a tendency to sweat excessively, polyuria, polydipsia, or sensitivity to heat and cold.<\/p>\n
ALLERGIES: Sulfur allergy is reported.<\/p>\n
O.<\/u><\/strong><\/p>\n
Physical exam<\/strong>: Vital signs<\/strong>: BP- 138\/86 mmHg, PR-86, RR-19, Temp- 98.9, SpO2-98% on room air, Ht- 5\u20199\u201d, Wt- 210 lbs., BMI-31.01<\/p>\n
GENERAL: a female who is obese and adequately attired. Clear speaking, the patient is focused and aware X4. The patient\u00a0responds to inquiries adequately and is not visibly distressed.<\/p>\n
HEENT: Head: normal-sized, trauma-free, and without scars. Eye: Sclera and conjunctiva are clear. No significant redness, discharge, or tearing. Ear: Typical pinna with an unobstructed tympanic membrane. It is normal for the external auditory canal. Nose: nasal mucous membrane that is wet. No sinuses or discomfort to the touch. Throat: pink, wet mucous membrane in the mouth. The tonsils and posterior pharynx are not erythematous, and the uvula is in the middle.<\/p>\n
MUSCULOSKELETAL: Gait and musculoskeletal development are normal. displays a healthy body posture without any joint or bone swelling or abnormalities. Right thumb abduction shows weakness, with a 3\/5 poor strength. Positive Hoffmann-Tinel and Phalen indicators. All the muscles of the other limb are strong and their tendon reflexes are normal.<\/p>\n
NEUROLOGICAL: Aware and well-grounded in time, location, and people. quite helpful throughout the assessment. All of the cranial nerves are mostly unharmed. demonstrates typical reactions. The right hand’s middle finger, thumb, and index finger all feel numb and tingly.<\/p>\n
Diagnostic results<\/strong>: The complete blood count (CBC) reveals a white blood cell count (WBC) of 8.9. Additionally, a comprehensive metabolic panel (CMP) including differentials is performed.\u00a0 The glucose level is measured at 125, while the HgbA1c level is recorded as 4.5%, indicating the need to exclude any potential presence or occurrence. Neuropathy associated with type 2 diabetes mellitus (T2DM). The concentration of C-reactive protein in the sample is 4.2 mg\/L (Attal & Didier Bouhassira, 2023).<\/p>\n
Diagnostic Tests:<\/strong><\/h2>\n
- \n
- An X-ray examination of the right wrist was conducted to assess the presence of arthritic changes (Genova et al., 2020).<\/li>\n
- Test for bone density to rule out osteoporosis.<\/li>\n
- nerve conduction analysis.<\/li>\n
- Manual: Tinel sign and Durkans Test (Zhang et al., 2020).<\/li>\n<\/ul>\n
A<\/u><\/strong>.<\/u><\/p>\n
Differential Diagnoses:<\/strong><\/h2>\n
- \n
- Carpal tunnel syndrome (CTS): This condition is characterized by symptoms such as tingling and numbness in the fingers, which occur due to compression of the median nerve within the carpal tunnel (Malakootian et al., 2022). This condition is commonly regarded as an occupational disease characterized by repetitive wrist and finger extension and flexion. However, certain cases of CTS may have an unknown cause, and the risk of developing CTS can be influenced by various factors, including genetic and acquired factors. A nerve conduction study is a precise diagnostic tool used to identify both normal and abnormal values of nerve function. Diagnostic laboratory results can also be utilized for the identification of increased levels of inflammatory markers. The patient exhibits multiple risk factors for developing this disease, including occupational factors and obesity.<\/li>\n
- Peripheral neuropathy: This condition\u00a0is linked to hand numbness. The patient’s gender, familial history, and weight contribute to their increased risk of developing type 2 diabetes mellitus (T2DM) (Selvarajah et al., 2019). Peripheral neuropathy is a frequently observed symptom associated with T2DM, characterized by a gradual onset. A two-point discrimination test was conducted, revealing decreased sensitivity in the patient’s right arm. The patient reports no decrease in sensation in the lower extremities. If the patient experiences altered symptoms and exhibits new-onset neuropathy in the lower extremities, I will contemplate reevaluating the A1C levels and potentially diagnose diabetic peripheral neuropathy based on diagnostic assessments. Diabetic individuals exhibit significant declines in hand and finger dexterity relative to their healthy counterparts.<\/li>\n
- Wartenberg\u2019s syndrome: This condition\u00a0presents as paresthesia or pain occurring along the radial aspect of the forearm, with symptoms radiating toward\u00a0the thumb and middle fingers. The pain arises due to the compression of the superficial radial nerve. Potential external factors may include the presence of a wristwatch or objects exerting pressure on the nerve (Kuschner & Berihun, 2021). The technique of palpation in the vicinity of the radial nerve region is employed to detect potential masses located both superficially and deeply. The utilization of the Tinel’s sign aids in the confirmation of this particular diagnosis.<\/li>\n
- Lupus: This\u00a0is an autoimmune disease characterized by immune system dysfunction, resulting in inflammation, a high body temperature, joint pain, malaise, and rash. DNA methylation is a specific and reliable biomarker for the diagnosis of lupus, exhibiting cell-type specificity (Fanouriakis et al., 2020). DNA methylation is more prominent in patients with active disease compared to those in remission. The lupus band test (LBT) is a direct immunofluorescent approach conducted through skin biopsy. It is particularly valuable in cases where clinical and laboratory data are inconclusive for diagnosing lupus.<\/li>\n
- Type 2 Diabetes Mellitus (T2DM): The patient is at a heightened risk of developing T2DM. In the event of a gradual increase in the patient’s HbA1c, it is recommended to implement a prediabetes protocol involving lifestyle modifications such as dietary changes, exercise, and regular monitoring of HbA1c levels. Diabetic peripheral neuropathy (DNP) is characterized by progressive metabolic and inflammatory alterations that result in impaired daily functioning and reduced independence (Wu et al., 2021). Fasting lipid levels should be included in laboratory tests to assess cholesterol levels and provide education on cholesterol, triglycerides, LDL, and HDL levels.<\/li>\n<\/ol>\n
\u00a0<\/strong><\/p>\n
\u00a0<\/strong><\/p>\n
References<\/strong><\/h2>\n
Attal, N., & Didier Bouhassira. (2023).\u00a0Neuropathic Pain<\/em>. https:\/\/doi.org\/10.1093\/med\/9780197616345.001.0001<\/a><\/p>\n
Fanouriakis, A., Tziolos, N., Bertsias, G., & Boumpas, D. T. (2020). Update \u039fn the Diagnosis and Management of Systemic Lupus Erythematosus.\u00a0Annals of the Rheumatic Diseases<\/em>,\u00a080<\/em>(1), annrheumdis-2020-218272. https:\/\/doi.org\/10.1136\/annrheumdis-2020-218272<\/a><\/p>\n
Genova, A., Dix, O., Saefan, A., Thakur, M., & Hassan, A. (2020). Carpal Tunnel Syndrome: A Review of Literature.\u00a0Cureus<\/em>,\u00a012<\/em>(3). https:\/\/doi.org\/10.7759\/cureus.7333<\/a><\/p>\n
Kuschner, S. H., & Berihun, H. (2021). Robert Wartenberg Syndrome and Sign: A Review Article.\u00a0The Open Orthopaedics Journal<\/em>,\u00a015<\/em>(1), 13\u201316. https:\/\/doi.org\/10.2174\/1874325002115010013<\/a><\/p>\n
Malakootian, M., Soveizi, M., Gholipour, A., & Oveisee, M. (2022). Pathophysiology, Diagnosis, Treatment, and Genetics of Carpal Tunnel Syndrome: A Review.\u00a0Cellular and Molecular Neurobiology<\/em>. https:\/\/doi.org\/10.1007\/s10571-022-01297-2<\/a><\/p>\n
Selvarajah, D., Kar, D., Khunti, K., Davies, M. J., Scott, A. R., Walker, J., & Tesfaye, S. (2019). Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention.\u00a0The Lancet Diabetes & Endocrinology<\/em>,\u00a07<\/em>(12), 938\u2013948. https:\/\/doi.org\/10.1016\/s2213-8587(19)30081-6<\/a><\/p>\n
Wu, B., Niu, Z., & Hu, F. (2021). Study on Risk Factors of Peripheral Neuropathy in Type 2 Diabetes Mellitus and Establishment of Prediction Model.\u00a0Diabetes & Metabolism Journal<\/em>,\u00a045<\/em>(4), 526\u2013538. https:\/\/doi.org\/10.4093\/dmj.2020.0100<\/a><\/p>\n
Zhang, D., Chruscielski, C., Blazar, P., & Earp, B. (2020). Accuracy of Provocative Tests for Carpal Tunnel Syndrome.\u00a0Journal of Hand Surgery Global Online<\/em>,\u00a02<\/em>(3), 121\u2013125. https:\/\/doi.org\/10.1016\/j.jhsg.2020.03.002<\/a><\/p>\n
A Sample Answer 2 For the Assignment: NURS 6512 Assignment 3 Digital Clinical Experience Comprehensive (Head-to-Toe) Physical Assessment IN<\/strong><\/h2>\n
Title: <\/strong> NURS 6512 Assignment 3 Digital Clinical Experience Comprehensive (Head-to-Toe) Physical Assessment IN<\/strong><\/h2>\n
\u00a0<\/strong><\/p>\n
OBJECTIVE DATA<\/strong><\/h3>\n
<\/h3>\n
Vital signs:<\/strong> Respiration- 15<\/p>\n
Temp- 37.2 C<\/p>\n
Heartrate – 78<\/p>\n
SpO2- 99%<\/p>\n
- \n
- Height: 170 cm<\/li>\n
- Weight: 84 kg<\/li>\n
- BMI: 29.0<\/li>\n
- Blood Glucose: 100<\/li>\n
- RR: 15<\/li>\n
- HR: 78<\/li>\n
- BP:128 \/ 82<\/li>\n
- Pulse Ox: 99%<\/li>\n
- Temperature: 99.0 F<\/li>\n<\/ul>\n
General:<\/strong> Jones is alert oriented, seated upright on examination table, and is in no distress. She is well-nourished, developed, and dressed appropriately with good hygiene.<\/p>\n
HEENT: <\/strong>Head is normocephalic, atraumatic. Eyes bilateral with equal hair distribution on lashes and eyebrows. No lesions on lids, no edema or ptosis. Pink conjunctiva, white sclera, PERRLA bilaterally, intact extraocular eye movements, and no nystagmus. Mild retinopathic changes on right. Left fundus with sharp disc margins, no hemorrhages. Snellen: 20\/20 right eye, 20\/20 left eye with corrective lenses. TMs intact and pearly gray bilaterally, positive light reflex. Whispered words heard bilaterally. Frontal and maxillary sinuses nontender to palpation. Nasal mucosa moist and pink, septum midline. Oral mucosa moist without ulcerations or lesions, uvula rises midline on phonation. Gag reflex intact. Dentition without evidence of caries or infection.<\/p>\n
Neck: <\/strong>Thyroid smooth without nodules, no goiter. No lymphadenopathy.<\/p>\n
Chest\/Lungs: <\/strong>Lung sounds clear and voice is present in all areas. Spanish symmetrically. Chest anterior and posterior normal upon inspection. fremitus equal bilaterally. Chest is symmetric with respiration, clear to auscultation bilaterally without cough or wheeze. Resonant to percussion throughout. In office spirometry: FVC 3.91 L, FEV1\/FVC ratio 80.56%.<\/p>\n
Heart\/Peripheral Vascular: <\/strong>Pirated 2 + with no thrill or bruit bilaterally. PMI non-discplaced. S1 and S2 only regular rhythm. No bruit in aorta or any other arteries. Capillary refill is less than 3 seconds in fingers and toes no edema is present. Heart rate is regular, S1, S2, without murmurs, gallops, or rubs. Bilateral carotids equal bilaterally without bruit. PMI at the midclavicular line, 5th intercostal space, no heaves, lifts, or thrills. Bilateral peripheral pulses equal bilaterally, capillary refill less than 3 seconds. No peripheral edema.<\/p>\n
Abdomen: <\/strong>bowel sounds are normal in all quadrants. moves bowels regularly. Abdomen is soft with no Masses. liver is one centimeter below the right costal margin. Quadrants are tympanic and spleen is Not dull in sound. Kidney is not palpable no masses are present<\/p>\n
<\/p>\n
Abdomen protuberant, symmetric, no visible masses, scars, or lesions, coarse hair from pubis to umbilicus. Bowel sounds are normoactive in all four quadrants. Tympanic throughout to percussion. No tenderness or guarding to palpation. No organomegaly. No CVA tenderness.<\/p>\n
Genital\/Rectal: <\/strong>–<\/h2>\n
Musculoskeletal: <\/strong>Range of motion in all areas of full or muscle strength or 5 out of 5 no CVA tenderness. DTR 2+. Strength 5\/5 bilateral upper and lower extremities, without swelling, masses, or deformity and with full range of motion. No pain with movement.<\/p>\n
\u00a0<\/strong><\/p>\n
Neurological: <\/strong>for the feet especially left foot area. Patient is able to sense position of body fingers and toes. Graphesthesia normal sense. Patient is oriented to time person and place. Heel to Shin normal. Normal graphesthesia, stereognosis, and rapid alternating movements bilaterally. Tests of cerebellar function normal. DTRs 2+ and equal bilaterally in upper and lower extremities. Decreased sensation to monofilament in bilateral plantar surfaces.<\/p>\n
Skin: <\/strong>Acne is present on the face. Skin is normal. Norwegians or abnormalities in the nails. Old scar is present on the left shin.<\/p>\n
Scattered pustules on face and facial hair on upper lip, acanthosis nigricans on posterior neck. Nails free of ridges or abnormalities.<\/p>\n
\u00a0<\/strong><\/p>\n
Diagnostic results: <\/strong>None<\/h2>\n
\u00a0<\/strong><\/p>\n
ASSESSMENT: <\/strong>Jones is a 28-year-old female that has come today for her pre-employment assessment. She appears well dressed and responsive. She is diabetic and asthmatic, which are controlled. She uses corrective lenses. She has normal sleeping cycle. She engages in active physical activity and has dietary modifications for diabetes control. She monitors her blood glucose levels on a daily basis. She also monitors her peak flow to track asthma and uses albuterol inhaler to manage its symptoms. She denies any current acute health problems. \u00a0<\/strong><\/p>\n
\u00a0<\/strong><\/p>\n
PLAN: <\/strong>This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.<\/em><\/p>\n
S.<\/u><\/strong><\/h3>\n
CC<\/strong>: \u201cI have a headache around my forehead.\u201d<\/p>\n
HPI<\/strong>: J.K.L is a 40-year-old African American female who presents with a complaint of a headache across her forehead for a week. The headache is squeezing and feels like pressure behind the eyes. It is non-radiating. The headache is constant and varies in severity ranging from 2\/10 at its best to 8\/10 at its worst. It is usually worse in the morning and while bending. Acetaminophen reduces the severity of the headache to 4\/10 and occasionally 2\/10. It is associated with fever, postnasal drip, nasal congestion, sneezing, and occasional non-productive cough. She takes Sudafed HCL 120 mg every 12 hours to obtain some relief. The symptoms have significantly impaired her concentration at work and made her feel very tired. Finally, she reports a head cold three weeks ago.<\/p>\n
Current Medications<\/strong>: Pseudoephedrine 120 mg BID for nasal congestion and acetaminophen for headaches.<\/p>\n
Allergies: <\/strong>She has no known food and drug allergies.<\/p>\n
Past Medical History<\/strong>: During her last visit to the primary care physician 2 months ago, she was noted to be prehypertensive and was advised on lifestyle modifications. No prior hospitalization. No previous surgeries or blood transfusions.<\/p>\n
Social History<\/strong>: She is married with two children both alive and well. She works as a secretary Her husband is a college teacher. She neither drinks alcohol nor smokes tobacco. She does not use marijuana or other illicit drugs. She strictly adheres to dietary advice from her nutritionist and she exercises regularly. Denies caffeine intake.<\/p>\n
Family History<\/strong>: Father alive aged 60 years and with hypertension while her mother is 58 years old alive and well. Her brother and sister are 35 and 20 years old respectively, alive and well. Her paternal grandfather died at the age of 80 years due to a heart attack while her paternal grandmother is 78 years and is hypertensive. Her maternal grandfather is 77 years with a history of type 2 diabetes and high cholesterol while her maternal grandmother died at the age of 70 years due to a stroke. No family history of malignancies, mental illness, asthma, sickle cell, or diabetes.<\/p>\n
ROS<\/strong>:<\/h2>\n
GENERAL: Reports fatigue and occasional fever. Denies weight loss, night sweats, and chills.<\/p>\n
HEENT: \u00a0Reports headaches, nasal congestion, post nasal drip, and sneezing. No blurring of vision, visual loss, hearing loss, tinnitus, nose bleeds, ear pain, mouth sores, or sore throat.<\/p>\n
SKIN: \u00a0no skin lesion or rashes. No abnormal pigmentation.<\/p>\n
CARDIOVASCULAR: Negative for palpitations, chest pain, paroxysmal nocturnal dyspnea, and peripheral limb edema.<\/p>\n
RESPIRATORY: \u00a0Occasional non-productive cough. No difficulty in breathing, dyspnea, or orthopnea.<\/p>\n
GASTROINTESTINAL: Reports loss of appetite and occasional nausea and vomiting. Denies change in bowel habits, abdominal pain, or distention.<\/p>\n
GENITOURINARY:\u00a0No frequency, dysuria, nocturia, and polyuria. No vaginal itchiness or abnormal vaginal discharge.<\/p>\n
NEUROLOGICAL: Reports headache. Denies dizziness, lightheadedness, numbness, tingling, loss of sensation, syncope, and convulsion.<\/p>\n
MUSCULOSKELETAL: No muscle pain, joint pains, muscle weakness, or muscle swelling.<\/p>\n
HEMATOLOGIC: \u00a0No anemia, easy bruising, or bleeding.<\/p>\n
LYMPHATICS: Normal lymph nodes<\/p>\n
PSYCHIATRIC: \u00a0Denies anxiety, depression, suicidal ideations, or hallucinations.<\/p>\n
ENDOCRINOLOGIC: Denies heat or cold intolerance, polyphagia, and polydipsia.<\/p>\n
ALLERGIES: \u00a0Reports no allergies.<\/p>\n
O.<\/u><\/strong><\/h3>\n
Physical exam<\/strong>:<\/h2>\n
VITAL SIGNS: BP 125\/78 mmHg, HR 88 b\/min, Temp 99. 8 F, RR 20 b\/min, saturation 95% on room air, Height 168 cm, weight 76 Kg. Pain level 5\/10<\/p>\n
GENERAL: A middle-aged African-American female, well kempt, not in any form of respiratory distress but slight discomfort. Maintains eye contact, coherent speech, and a stable mood. Well-hydrated and nourished. No palmar or conjunctival pallor, jaundice, central or peripheral cyanosis, cervical or inguinal lymphadenopathy, and peripheral limb edema.<\/p>\n
HEENT: Normocephalic and atraumatic head. Non-tender scalp. Bilateral eyes with pink conjunctiva and white sclera. Pupils equally and bilaterally reacting to light, no ptosis or lid edema. Normal extraocular movements. Bilateral ears present, no impaction or skin lesions, tympanic membrane pearly grey bilaterally, and positive white reflex. Both nares are present and are discharging mucus, midline nasal septum, and pink and soft nasal mucosa. Tender maxillary and frontal sinus. Moist and pink oral mucosa, no oral lesions or ulceration. Normal dentition and teeth alignment.<\/p>\n
NECK: Soft neck. The trachea is central. Full range of motion, non-tender, no cervical lymphadenopathy, and no thyroid enlargement.<\/p>\n
CARDIOVASCULAR: Regular heart rate. Normoactive precordium. Point of maximal impulse in the 5th<\/sup> intercostal space in the midclavicular line. S1 and S2 head, no murmurs, thrills, gallops, rubs, or heaves.<\/p>\n
RESPIRATORY: Symmetrical chest that moves with respiration. No scars or skin lesions. Equal chest expansion and equal tactile fremitus bilaterally. Equal air entry, vesicular breath sounds, no wheezes, and crackles, and equal vocal fremitus in all lung zones.<\/p>\n
NEUROLOGICAL: GCS 15\/15, oriented to time, place, and person, intact short-term and long-term memory, good concentration, and a clear coherent speech. Cranial nerves 1 to 12 intact. Normotonic across all joints, normal bulk, and power 5\/5 across all muscle groups in upper and lower extremities, deep tendon reflexes 2+ and equal bilaterally in upper and lower limbs. Intact monofilament sensation across all dermatomes, good bowel, and bladder function. No spinal tenderness, normal gait, coordination, graphesthesia, and stereognosis. Normal finger nose, heel to the shin, and rapid alternating movements tests.<\/p>\n
Diagnostic results<\/strong>:<\/h2>\n
J.K.L appears to have an inflammatory\/infectious condition. Consequently, complete blood count and inflammatory markers particularly CRP and ESR are paramount. Similarly, bacterial or fungal cultures obtained endoscopically or by direct sinus aspiration are required to identify the possible pathogen. Additionally, a skin prick test is essential to exclude allergic rhinitis. Imaging modalities principally Sinus CT and MRI are recommended to evaluate for rhinosinusitis and intraorbital or intracranial involvement.<\/p>\n
<\/p>\n
A<\/u><\/strong>.<\/u><\/h3>\n
Differential Diagnoses<\/strong><\/h2>\n
Acute Sinusitis- <\/strong>refers to the inflammation of sinuses lasting less than 4 weeks (DeBoer & Kwon, 2022). The condition is more common in females and particularly during early fall to early spring (DeBoer & Kwon, 2022). It is most commonly caused by viral infection following a common cold although bacteria and fungi are not uncommon etiologies. J.K.L presents with clinical features that are typical of acute sinusitis including fatigue, fever, headache, facial pain, and pressure worse on bending (DeBoer & Kwon, 2022). Maxillary sinuses and frontal sinuses appear to be the affected sinuses in her as evidenced by pain around the forehead and tenderness of the maxillary and frontal sinuses (DeBoer & Kwon, 2022).<\/p>\n
Rhinitis- <\/strong>Refers to the inflammation of the nasal mucosa. J.K.L presents with clinical manifestations suggestive of rhinitis including sneezing, nasal congestion, postnasal drip, and rhinorrhea (Liva et al., 2021). Similarly, she reports a \u201chead cold\u201d three weeks ago. Rhinitis is mostly caused by an upper respiratory infection or type 1 hypersensitivity reaction (Liva et al., 2021). However, an upper respiratory tract infection is likely the cause in her case.<\/p>\n
Cluster headache- <\/strong>Cluster headache is a type of primary headache that is usually unilateral retro-orbital and characterized by sharp and stabbing pain (Goadsby et al., 2018). Cluster headache may present with symptoms of lacrimation, nasal congestion, rhinorrhea, ptosis, or miosis (Goadsby et al., 2018). However, it is unlikely the diagnosis in her as cluster headache usually lasts for a brief period. Similarly, cluster headaches mostly awake the patient at night.<\/p>\n
Migraine headache- <\/strong>Migraine headache is another type of primary headache that may be preceded with or without aura. It is usually pulsating and moderate to severe (Pescador Ruschel & O, 2022). It is common in young women. However, it is unlikely the diagnosis as migraines last 4 to 72 hours if untreated and are typically associated with nausea, vomiting, photophobia, and phonophobia (Pescador Ruschel & O, 2022).<\/p>\n
Rebound headache<\/strong>– Commonly referred to as medication overuse headache. Rebound headache predominantly occurs in individuals with primary headaches who overuse analgesia (Micieli & Robblee, 2018). Rebound headaches are more common in females and individuals less than 50 years. Drugs precipitating this headache include barbiturates, acetaminophen, opioids, ergotamine, and triptans (Micieli & Robblee, 2018). However, this is an unlikely diagnosis in J.K.L as a diagnosis of primary headache hasn\u2019t been established.<\/p>\n
<\/p>\n
References<\/strong><\/h2>\n
DeBoer, D. L., & Kwon, E. (2022).\u00a0Acute Sinusitis<\/em>. https:\/\/pubmed.ncbi.nlm.nih.gov\/31613481\/<\/a><\/p>\n
Goadsby, P., Wei, D.-T., & Yuan Ong, J. (2018). Cluster headache: Epidemiology, pathophysiology, clinical features, and diagnosis.\u00a0Annals of Indian Academy of Neurology<\/em>,\u00a021<\/em>(5), 3. https:\/\/doi.org\/10.4103\/aian.aian_349_17<\/a><\/p>\n
Liva, G. A., Karatzanis, A. D., & Prokopakis, E. P. (2021). Review of rhinitis: Classification, types, pathophysiology.\u00a0Journal of Clinical Medicine<\/em>,\u00a010<\/em>(14), 3183.
- Neurological (Practice)<\/li>\n<\/ul>\n
- Click the\u00a0Week 9 Assignment 1 <\/strong>link. You will also be able to \u201cView Rubric\u201d for grading criteria from this area.<\/li>\n