During the past several years, simulation pedagogy has taken off in leaps and bounds. The breadth of simulation design and implementation has become woven into the fabric of the majority of nursing education in the United States and beyond. As faculty members who teach in both graduate and undergraduate courses, the authors of this chapter find that simulation can be challenging to both the novice and seasoned educator. This chapter focuses on the use of simulation in the fundamental physical assessment course. The use of simulation technology is especially useful in creating the equivalent of “muscle memory” for the students because of the ability to do frequent and repetitive exercises using this technology. It is especially useful in assisting students to learn, develop, and mature their assessment skills. The chapter briefly describes specific objectives for simulation usage within a specific course and the overall program.
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- Go to chapter: Primary Care Patients With Gastrointestinal Problems: Graduate Program Advanced Physiology and Pathophysiology
Primary Care Patients With Gastrointestinal Problems: Graduate Program Advanced Physiology and Pathophysiology
This three-credit course is mandatory for all graduates of accredited master’s programs in nursing. It is commonly referred to as one of the “three Ps” (physical assessment, physiology and pathophysiology, and pharmacology). The course is a prerequisite for any of the specialty track courses for nurse practitioners (NPs), midwives, and nurse anesthetists. Analysis of physiologic responses and implications of the genome model to illness are included. Interpretation of laboratory data for patient management of acute and chronic disease is discussed. Students analyze case studies of hospitalized and primary care patient scenarios. This scenario is focused on gaining experience with analyzing patients’ differential diagnoses and explaining the etiology for each diagnosis. In identifying patient signs and symptoms to determine three differential diagnoses, the students gain much confidence in their reasoning skills. Also, the case provides some application of assessment skills for students to collect data regarding this patient’s Gastrointestinal (GI) complaints.
Simulation-based learning occurs in an innovative fashion for baccalaureate and nurse practitioner students. The objective of simulation- based pedagogy is to provide opportunities for baccalaureate and nurse practitioner students to acquire critical thinking skills before encounters in the clinical setting. In addition, the development of role acquisition in the context of interprofessional learning is a key feature unique to simulation. This chapter introduces the concepts and techniques of physical assessment in the context of the nursing process. High- fidelity simulation provides opportunity for these undergraduate nursing students to apply advanced health assessment skills and delivery of care in the context of an acute, high- risk trauma resuscitation. Simulation learning is intrinsically safe, adaptive, and fun. Student anxiety is lessened through repetitive practice of responsive actions and debriefing as a group process provides insight into the broad strokes of applied knowledge and team effort.
This chapter incorporates students’ knowledge of postsurgical patients, emphasizing operative assessment, problem recognition, interprofessional collaboration, and patient education for the prevention of postoperative complications. The authors of this chapter present a brief scenario about a patient who had an appendectomy and was in pain postoperatively. The primary objective of this scenario is to assess the prelicensure student’s ability to conduct a thorough postoperative assessment, recognize abnormal findings, and cluster cues to diagnose actual and potential problems. The authors incorporate elements of patient education, interprofessional collaboration and communication, infection control, and judgment in medication administration. To achieve the objectives of more complex scenarios, students need to have mastered the content on postoperative care, medication administration, and physical assessment, including identifying abnormal laboratory results. Use of simulation has grown as a learning tool and, in many programs, counts for a portion of clinical hours. Universities need to support this growth financially.
This chapter examines pre- and post conference expectations and activities, and forms to be used by the professor and the students. Prior to the first class, make copies of the syllabus, contact information sheet, weekly attendance sheet, scavenger hunt sheets, chart check form, guidelines for care plans, care plan form, math quiz, vocabulary quiz, medication forms, and resource materials. Medical-Surgical II students should be able to perform a physical assessment independently. The chapter introduces detailed guidelines for conducting modified physical assessments that balance obtaining the information required for health care interventions against the limited time available to the students in clinical classes. The clinical instructor should also notify the students that each of them will be tested on medications, side effects, desired effects, interactions, and dose calculations prior to being allowed to pass medications or regulate IV fluids on his or her assigned patient.
Obtaining an accurate and complete pediatric health history is essential when providing healthcare to children. The accuracy of the physical examination and diagnoses depends on whether the health history is accurate and complete. The pediatric healthcare provider must possess excellent communication skills when working with children and families to elicit the most accurate and complete health history. Communicating well and establishing rapport with the parent or primary caregiver and the child are the crucial first steps when obtaining the health history interview. The emergency pediatric health history is often conducted in urgent care clinics, emergency rooms, or pediatric intensive care units. This history involves the rapid collection of data in emergent, potentially life-threatening situations. Analysis of both subjective and objective data allows the provider to create a problem list, which is a consideration of all the possible diagnoses based on the information gathered through interviewing and examining the child.
Obtaining an accurate health history is the essential first step in the pediatric healthcare visit. The accuracy of the physical examination and diagnoses depends on whether the health history is accurate and complete. This chapter helps the student refine skills in obtaining the pediatric health history. It also helps the student to identify the type of history that needs to be obtained based on the reason for seeking care and how the various components of the health history differ according to age and developmental stage. It then helps the reader to demonstrate age and developmentally appropriate communication and interview skills when obtaining the health history. It presents the essential terminology, and critical thinking exercises in two formats: short answer, and case study. It also presents certification exam-style multiple choice questions (with answers) followed by blank sample documentation to show examples of subjective and objective findings that are necessary to record.
- Go to chapter: The Complete History and Physical Examination: From Start to Finish The Complete History and Physical Examination of the Pediatric Patient: From Start to Finish
The Complete History and Physical Examination: From Start to Finish The Complete History and Physical Examination of the Pediatric Patient: From Start to Finish
The pediatric physical examination differs from the adult examination in that the approach to the patient and the sequence of the examination differ according to age and developmental level. Together, the history and physical exam provide information that leads to the child's diagnosis and forms the basis for the provider's management plan. This chapter summarizes the complete, head-to-toe pediatric physical examination for each age group. When conducting the history and physical examination on a neonate or infant, it is essential to review the prenatal, neonatal, and postnatal histories. The toddler can be very challenging to examine. Younger toddlers, in particular, dislike being restrained and prefer to have the parent nearby during the examination. Beginning with the preschool age group, the physical examination can be conducted in a head-to-toe manner while the child is on the examination table, lying supine, dressed in a gown.
Assessment of the newborn infant requires specialized knowledge and skills. During the transition from intrauterine to extrauterine life, and extending through the neonatal period (first 28 days of life), the infant undergoes numerous physiologic changes. Providers require an understanding of neonatal anatomy and physiology as well as the skills to accomplish a comprehensive infant assessment. This chapter reviews newborn assessment, including a comprehensive history and a detailed physical examination. Assessment of the newborn infant is a critical component of pediatric care. The chapter provides the basic techniques of newborn assessment. Proficiency is attained through practice. The provider must be well prepared, using a systematic yet flexible approach. The experienced provider integrates multiple aspects of assessment; for example, behavior is evaluated during the physical assessment, rather than separately. Parents should be included in the examination, providing an excellent opportunity for education.
- Go to chapter: Assessment of the Cardiovascular System Assessment of the Pediatric Cardiovascular System
Cardiovascular assessment is very important in the assessment of both well and acutely ill children, as well as in children with chronic conditions. The cardiovascular evaluation of a child includes taking a detailed history and conducting a comprehensive physical examination that includes inspection, palpation, and auscultation. Further evaluation is recommended if the history and physical examination findings are suggestive of congenital or acquired heart disease. Taking a comprehensive health history is one of the most important steps in evaluating whether a child is at risk for or already has heart disease. Laboratory tests, electrocardiogram, and chest films are generally abnormal only when the congenital heart disease or acquired heart disease is significant enough to cause hemodynamic changes. However, these diagnostic tests can provide useful information about the progression of the disease as well as the health status of children living with heart disease.