[Solved] NR509 Week 6: i-Human Virtual Patient Encounter

COURSE:

NR509: Advanced physical assessment

NR509 Week 6: Assessment of the Neurological and Musculoskeletal Systems: Kathleen Parks

General Instructions

Access i-Human by clicking the link on the following page. Click the blue bar to launch the activity in a new browser window. The case does not need to be completed in one sitting; it can be re-entered at the same point at a later time.

All graded documentation, including the management plan, must be completed within the i-Human platform. Follow the i-Human Documentation GuideLinks to an external site. to complete your client’s electronic health record (EHR) and management plan. Use current APA Style Standards to format citations and references in the management plan and reflection. Use APA StyleLinks to an external site. and APA Academic WriterLinks to an external site. for formatting and grammar assistance.

  1. Include the following sections (detailed criteria listed below and in the Grading Rubric)

Complete the following components in the i-Human Virtual Patient Encounter.

  1. Focused Health History
    1. Complete a focused health history. Scores are automatically calculated within the i-Human platform when the health history is submitted.
  2. Focused Physical Exam
    1. Complete a focused physical exam. Scores are automatically calculated within the i-Human platform when the health history is submitted.
  • EHR Documentation (Subjective Data): Document the history of present illness (HPI) and focused review of systems (ROS). Documentation must be:
    1. accurate
    2. detailed
  • written using professional terminology
  1. pertinent to the chief complaint
  2. includes subjective findings only
  1. EHR Documentation (Objective Data): Document physical exam findings. Documentation must be:
    1. accurate
    2. detailed
  • written using professional terminology
  1. pertinent to the chief complaint
  2. include objective findings only
  1. Key Findings: Organize key findings from the history and physical exam.
  2. Problem Statement: Document a brief, accurate problem statement using professional language. Include the following components:
    1. name or initials, age
    2. chief complaint
  • positive and negative subjective findings
  1. positive and negative objective findings
  • Management Plan:Use the expert diagnosis provided to create a pertinent comprehensive evidence-based management plan. If a specific component of the management plan is not warranted (i.e., no referrals are appropriate for the virtual patient) document that no intervention is warranted. Include the following components:
    1. diagnostic tests
    2. medications: type a specific prescription for each medication, including over-the-counter medications
  • suggested consults/referrals
  1. client education
  2. follow-up, including time interval and specific symptomatology to prompt a sooner return
  3. cite at least one relevant scholarly source and provide rationale for interventions as defined by program expectations
  • Reflection: Download this worksheetLinks to an external site.One rule is to always include “the worst-case scenario” in your differential diagnosis and make sure you have ruled out this possibility based on your findings and patient assessment. Your goal is to minimize the risk of missing unusual or infrequent conditions such as meningococcal meningitis, bacterial endocarditis, pulmonary embolus, or subdural hematoma that are particularly ominous.

Address the following question:  What are the “red flags” in this case? Based on your pertinent key findings, what is “the worst-case scenario”? What lessons did you learn from this case that you can apply to your future professional practice? Include the following components:

  1. type 150-300 words in a Microsoft Word document
  2. demonstrate clinical judgment appropriate to the virtual patient scenario
  3. provide rationales for each intervention and cite at least one relevant scholarly source as defined by program expectations
  4. communicate with minimal errors in English grammar, spelling, syntax, and punctuation

 

Solution

Reflecting on my clinical reasoning, I realized that my thought process was largely influenced by my previous experiences and knowledge. For example, when the patient presented with chest pain, I immediately thought of cardiac conditions due to…………..$5