NURS 6512 Assessment of the genitalia and rectum Assignment

NURS 6512 Assessment of the genitalia and rectum Assignment

Walden University NURS 6512 Assessment of the genitalia and rectum Assignment-Step-By-Step Guide

 

This guide will demonstrate how to complete the Walden University  NURS 6512 Assessment of the genitalia and rectum Assignment assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

 

How to Research and Prepare for NURS 6512 Assessment of the genitalia and rectum Assignment

 

Whether one passes or fails an academic assignment such as the Walden University  NURS 6512 Assessment of the genitalia and rectum Assignment depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

 

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

 

How to Write the Introduction for  NURS 6512 Assessment of the genitalia and rectum Assignment 

 

The introduction for the Walden University  NURS 6512 Assessment of the genitalia and rectum Assignment is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

 

How to Write the Body for  NURS 6512 Assessment of the genitalia and rectum Assignment 

 

After the introduction, move into the main part of the  NURS 6512 Assessment of the genitalia and rectum Assignment assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

 

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

 

How to Write the Conclusion for  NURS 6512 Assessment of the genitalia and rectum Assignment 

 

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

 

How to Format the References List for  NURS 6512 Assessment of the genitalia and rectum Assignment

 

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6512 Assessment of the genitalia and rectum Assignment

Assessment of the genitalia and rectum is vital in depicting genitourinary and gastrointestinal abnormalities respectively. A rectal examination is necessary to complete an abdominal exam. Meanwhile, assessment of the genitalia is usually sensitive and must be done in the presence of a chaperone. The purpose of this paper is to explore the potential history, physical exam, and differential diagnosis based on a case scenario of T.S. a 32-year-old woman who presents with dysuria, frequency, and urgency for two days. She is sexually active and has had a new partner for the past three months.

Christian values are essential to embody in all aspects of life. While GCU utilizes these values as a foundational component for educational standards, these should also be standard for how students are influenced in their academic performance as well. Academic dishonesty, which is the opposite of academic integrity, plagues all academic levels. There are several reasons why I think students are tempted into dishonesty including pressure for success, lack of understanding about what constitutes plagiarism, and not fully understanding the entire process of academia. Integrity is the intrinsic belief to do the right thing even when no one is watching and is an essential value of the Christian doctrine. When students believe and practice integrity, they will be able to apply this outside of the classroom and to other aspects of life. If students are engaging in academic dishonesty, this may be suggestive of a lack of integrity outside of the classroom as well. Lack of integrity is one example of the brokenness seen in society today. It shows a desire for success regardless of the means to get there or if there was any actual self-growth in the achievement of success. Having an educational infrastructure based on Christian values will not only foster academic success but will support students to apply these values beyond the classroom and become a part of their daily lives.

Subjective

A triad of urgency, frequency, and dysuria characterizes a pathology that is most likely in the urinary tract. Consequently, it is essential to inquire about associated symptoms such as hematuria, fever, and malaise. Association with malaise and fever is common in urinary tract infections. Similarly, it is important to inquire about the presence of any abnormal vaginal discharge, and burning sensation during urination since she is sexually active and a sexually transmitted infection might be the cause of her symptoms. Likewise, changes in the smell and color of the urine must be elicited as well as associated suprapubic pain. Related to sexually transmitted infections, it is crucial to inquire about the number of sexual partners if similar symptoms have manifested in her partner or the use of protection during intercourse (Garcia & Wray, 2022).

Similarly, her last menstrual period must be known to determine if pregnant as this will impact the management (Bono et al., 2022). Additionally, a history of medication use, alcohol, smoking, and use of illicit drugs must be elicited. A history of contact with an individual with a chronic cough or TB prior to the occurrence of the previous symptoms must be elicited as urogenital TB may present similarly. Finally, it is crucial to inquire about any history of trauma or recent urethral catheterization as these are common risk factors for urinary tract infections.

Objective

The vital signs are mandatory in this patient as it is a pelvic exam. In the general exam, the mental and nutrition status of the patient must be noted. Additionally, a complete abdominal exam must be conducted as the patient has flank pain and suprapubic tenderness. Palpation of the abdomen for any masses and percussion of the flank for costovertebral angle tenderness must be done (Bono et al., 2022). Similarly, complete respiratory and cardiovascular exams must be conducted as a routine during the assessment of any patient. Finally, a digital rectal examination must be performed to exclude associated rectal abnormalities.

Assessment

In addition to urinalysis, STI, and pap smear testing, a complete blood count and urine culture must be conducted as the patient presents with signs of infection. Similarly, a pregnancy test must be conducted as this may complicate urinary tract infections. Additionally, she has no appetite and therefore a random blood sugar must be done to exclude hypoglycemia. Similarly, urea, creatinine, and electrolyte must be conducted to check the renal function as the patient has flank pain. Finally, Inflammatory markers such as ESR and CRP as well as blood cultures must be done as the patient has flank pain which may indicate pyelonephritis (Bono et al., 2022). Imaging tests are not necessary for the diagnosis of lower UTI. However, the patient has flank pain, and therefore, a CT scan of the abdomen and pelvis with or without IV contrast as well as an ultrasound of the kidneys and bladder must be done to identify any pathologies and outline the architecture of the kidney and bladder (Belyayeva & Jeong, 2022)

The possible diagnoses include a urinary tract infection and a sexually-transmitted infection. Urinary tract infections refer to the infection of the bladder, urethra, ureters, or kidneys (Bono et al., 2022). UTIs are more common in women, a consequence of a short urethra and proximity of the anal and genital regions (Bono et al., 2022). A triad of frequency, dysuria, and urgency collectively defines the irritative lower urinary tract symptoms (Bono et al., 2022). Similarly, suprapubic tenderness is a key feature of lower urinary tract infections. However, the patient is also feverish and has flank pain which also denotes the potential for involvement of the upper urinary tract (Bono et al., 2022). T.S is also sexually active, a risk factor for urinary tract infection.

A sexually transmitted infection is another possible diagnosis. T.S is sexually active and she has had her new partner for the last three months which is a key risk factor for this condition (Garcia & Wray, 2022). Most STIs present with suprapubic pain. Most STIs are asymptomatic and if symptomatic manifests with urethral discharge, vaginal discharge, pruritus, and pain (Garcia & Wray, 2022). T.S was negative for the aforementioned features.

Other differential diagnoses include pyelonephritis, interstitial cystitis, and urethritis due to an STI. Pyelonephritis is of the renal pelvis and parenchyma (Belyayeva & Jeong, 2022). It is usually a complication of ascending bacterial infection of the bladder and manifests principally with frequency, dysuria, urgency, fever, malaise, flank pain, and suprapubic pain (Belyayeva & Jeong, 2022). Interstitial cystitis is a chronic noninfectious idiopathic cystitis associated with recurrent suprapubic pain (Daniels et al., 2018). It presents with urgency, frequency, suprapubic discomfort, and pain relieved by voiding. T.S has some of these features although the gradual onset of symptomatology and a duration of more than six weeks is required for the diagnosis of this condition (Daniels et al., 2018). Finally, urethritis secondary to an STI may present in females with only frequency, urgency, and dysuria with minimal or no vaginal discharge (Young et al., 2022).

Conclusion

Assessment of the genitalia and rectum is sensitive and may help identify abnormalities of the rectum and genitourinary tract. Most abnormalities of the genitourinary system particularly UTIs and STIs can be diagnosed clinically. Consequently, a comprehensive history and physical examination are mandatory. Most UTIs are common in females. Pregnancy must always be excluded in a patient presenting with features suggestive of a UTI.

References

Belyayeva, M., & Jeong, J. M. (2022). Acute Pyelonephritis. https://pubmed.ncbi.nlm.nih.gov/30137822/

Bono, M. J., Leslie, S. W., & Reygaert, W. C. (2022). Urinary Tract Infection. https://pubmed.ncbi.nlm.nih.gov/29261874/

Daniels, A. M., Schulte, A. R., & Herndon, C. M. (2018). Interstitial cystitis: An update on the disease process and treatment. Journal of Pain & Palliative Care Pharmacotherapy, 32(1), 49–58. https://doi.org/10.1080/15360288.2018.1476433

Garcia, M. R., & Wray, A. A. (2022). Sexually Transmitted Infections. https://pubmed.ncbi.nlm.nih.gov/32809643/

Young, A., Toncar, A., & Wray, A. A. (2022). Urethritis. https://pubmed.ncbi.nlm.nih.gov/30725967/

Sample Answer 2 for NURS 6512 Assessment of the genitalia and rectum Assignment

Genitourinary problems are among the public health concerns globally. Nurses and other healthcare providers adopt evidence-based interventions that would optimize patient outcomes in the treatment of these conditions. Subjective and objective data help nurses to formulate diagnoses and treatment plans. Therefore, this essay examines TS’s case study. TS has presented to the hospital complaining of dysuria, urgency, and frequency for the last two days. The essay focuses on topics that include additional subjective and objective information that should be obtained from the patient, if subjective and objective data supports the assessment, appropriate diagnostics, accepting or rejecting the diagnosis, and differential diagnoses to be considered for the patient.

Additional Subjective Information

Additional subjective information should be obtained from TS. Firstly, information about the character of her urine should be obtained. This includes information such as the smell and color of the urine. Bloodstained urine could indicate bladder problems while urine with a strong smell could imply that TS has a urinary tract infection. The nurse should also ask for information about the presence or absence of abnormal vaginal discharge. For instance, yellow or purulent vaginal discharge would indicate sexually transmitted infections. The character of TS’s symptoms should also be obtained. This includes seeking information on the factors that precipitate or alleviate her urinary symptoms. She should be asked about any activity that worsens or relieves her symptoms (Kaur & Kaur, 2021). The nurse should also assess her current level of pain using the pain rating scale. Pain rating could indicate the severity of her condition.

The nurse should also ask TS about her sexual habits. This includes sexual preferences and the use of protection when engaging in sexual intercourse. The information would help the nurse rule out causes such as sexually transmitted infections. Additional sexual-related information that should be obtained includes the use of contraceptives, the last menstrual period, and menstrual cycle problems. The nurse should also obtain information about any history of recurrent urinary tract infections. This would help determine if she has chronic urinary tract infections. Similarly, information about the history of sexually transmitted infections should be obtained to rule them out in her case. Information about her partner’s history of sexually transmitted infections and testing should also be obtained to rule out a risk of STD transmission. Information about TS’s social history is also needed. This includes data about smoking, dietary practices, and alcohol use (Bono et al., 2024). The nurse should also rule out the potential of heredity of TS’s problem. Information about a family history of health problems such as kidney disease or symptoms that TS has should be obtained.

Additional Objective Information

Additional objective information should be obtained in TS’s case to guide the development of an accurate diagnosis and treatment plan. Firstly, the nurse should provide information about TS’s general appearance. Information such as her overall grooming, weight changes, presence or absence of chills or fatigue should be included in the objective portion. Abdominal assessment should provide information about the presence or absence of organomegaly, or abnormal pulsations. The case study should also provide detailed information about urine description (Bono et al., 2024). This includes urine color, smell, and the presence or absence of pus or blood in the urine.

The nurse should also provide information about the assessment of the genitourinary system. Information such as the presence or absence of vaginal discharge, lesions, or trauma should be documented to rule out causes such as sexually transmitted infections and intimate partner violence. The nurse should also assess TS’s level of pain. She should use a pain rating scale to determine the severity of her pain and prioritize the treatment plan accordingly (Boon et al., 2021). Pain assessment should also include TS’s experiences of pain on abdominal palpation.

If the Assessment is Supported by Subjective and Objective Information

Subjective and objective information support TS’s assessment. Nurses obtain subjective information by asking patients questions that relate to their health problems and different body systems. The subjective data helps the nurse determine the severity of a health problem and its impact on the client’s health and overall well-being. TS’s case study has subjective information. They include her chief complaints, history of her presenting illness, surgical history, past medical history, medication use, allergies, and social history. Nurses obtain objective data from their patients by using methods such as inspection, palpation, auscultation, and percussion. The objective data validates subjective claims by the patient. The case study has objective information. They include TS’s vital signs, abdominal assessment, and diagnostics ordered.

Appropriate Diagnostics for the Case

Some diagnostic and laboratory investigations should be ordered in TS’s case study to guide develop an accurate diagnosis and treatment plan. Firstly, a urinalysis test should be performed to rule out urinary tract infections. A diagnosis of urinary tract infection will be made should her urine test reveal the presence of leucocytes and nitrites. The presence of proteins in urine will indicate cardiovascular problems such as hypertension while the presence of glucose would imply that TS has diabetes. The presence of ketones will indicate the possibility of dehydration. TS should also be tested for sexually transmitted infections. Blood tests, vaginal swabs, and urine samples should be taken to rule out sexually transmitted infections such as gonorrhea and chlamydia infections. An abdominal CT scan should also be performed to rule out causes such as kidney stones. MRI might also be needed to rule out kidney stones and other renal pathologies that could be associated with TS’s problems (Kaur & Kaur, 2021). Lastly, cervical screening for cervical cancer should be done. Cervical screening would also help rule out other causes such as vaginosis in TS’s case.

Accepting or Rejecting Current Diagnosis Differential Diagnoses

I would accept the current diagnosis. TS’s complaints align with those seen in patients with urinary tract infections and sexually transmitted infections. Often, patients with these conditions experience dysuria, urgency, frequency, and fever, which are present in TS’s case (Bono et al., 2024). Therefore, additional diagnostic and laboratory tests will help determine if TS is suffering from STDs or UTIs. TS’s history of engaging in unprotected sex with her new partner makes STDs among the probable diagnoses to be considered.

One of the differential diagnoses that should be considered for TS is perinephric abscess. Perinephric access is a condition that develops from the spread of infections from other regions of the genitourinary tract to the kidneys (Okafor & Onyeaso, 2024). The infections result in the development of abscesses. Patients experience symptoms that include fever, chills, nausea, vomiting, flank pain, and fatigue (Adams et al., 2020). Unlike urinary tract infections or STDs, patients with perinephric abscesses might not experience symptoms such as urinary frequency or dysuria.

The other differential diagnosis that should be considered for TS is urethral syndrome. Urethral syndrome is a genitourinary condition characterized by urinary frequency, urgency, suprapubic pain, and dysuria. It develops from any condition that causes urethral irritation and inflammation. The urethral syndrome can develop due to sexually transmitted infections, urinary tract infections, or the use of foods that irritate the urethra (Sell et al., 2021). A confirmed diagnosis of either UTI or STD might indicate its co-existence with urethral syndrome.

The last differential diagnosis that should be considered for TS is kidney stones. Kidney stones develop from crystal deposition in the kidneys. Factors such as dehydration, intake of diets rich in salt, and overweight or obesity predispose individuals to kidney stones. Patients experience symptoms such as severe, sharp back or flank pain, pain radiating to the groin or lower abdominal regions, and dysuria. Patients might also report passing red or brown urine, foul-smelling and cloudy urine, frequency, nausea and vomiting, chills, and fever (Thongprayoon et al., 2020; Wang et al., 2021). The absence of red or brown-colored urine and sharp pain show that kidney stones are not the cause of TS’s complaints.

Conclusion

Overall, additional subjective and objective information should be obtained in the case study. Subjective and objective data support the assessment. Additional diagnostics and laboratory investigations should be ordered to develop an accurate diagnosis and treatment plan. I accept the current diagnosis based on TS’s symptoms. The three differential diagnoses that should be considered in TS’s case study include kidney stones, urethral syndrome, and perinephric abscess.

 

 

References

Adams, M., Bouzigard, R., Al-Obaidi, M., & Zangeneh, T. T. (2020). Perinephric abscess in a renal transplant recipient due to Mycoplasma hominis: Case report and review of the literature. Transplant Infectious Disease, 22(5), e13308. https://doi.org/10.1111/tid.13308

Bono, M. J., Leslie, S. W., & Reygaert, W. C. (2024). Uncomplicated Urinary Tract Infections. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK470195/

Boon, H. A., Bruel, A. V. den, Struyf, T., Gillemot, A., Bullens, D., & Verbakel, J. Y. (2021). Clinical Features for the Diagnosis of Pediatric Urinary Tract Infections: Systematic Review and Meta-Analysis. The Annals of Family Medicine, 19(5), 437–446. https://doi.org/10.1370/afm.2684

Kaur, R., & Kaur, R. (2021). Symptoms, risk factors, diagnosis and treatment of urinary tract infections. Postgraduate Medical Journal, 97(1154), 803–812. https://doi.org/10.1136/postgradmedj-2020-139090

Okafor, C. N., & Onyeaso, E. E. (2024). Perinephric Abscess. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK536936/

Sell, J., Nasir, M., & Courchesne, C. (2021). Urethritis: Rapid Evidence Review. American Family Physician, 103(9), 553–558.

Thongprayoon, C., Krambeck, A. E., & Rule, A. D. (2020). Determining the true burden of kidney stone disease. Nature Reviews Nephrology, 16(12), Article 12. https://doi.org/10.1038/s41581-020-0320-7

Wang, Z., Zhang, Y., Zhang, J., Deng, Q., & Liang, H. (2021). Recent advances on the mechanisms of kidney stone formation (Review). International Journal of Molecular Medicine, 48(2), 1–10. https://doi.org/10.3892/ijmm.2021.4982

Patients are frequently uncomfortable discussing with healthcare professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

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To Prepare

• Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.
• Based on the Episodic note case study:
  • Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.
  • Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.
  • Consider what history would be necessary to collect from the patient in the case study.
  • 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.

The Lab Assignment

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

• Analyze the subjective portion of the note. List additional information that should be included in the documentation.
• Analyze the objective portion of the note. List additional information that should be included in the documentation.
• Is the assessment supported by the subjective and objective information? Why or why not?
• Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
• Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

By Day 7 of Week 10

Submit your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK10Assgn+last name+first initial.(extension)” as the name.
• Click the Week 10 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 10 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 10 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 10 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 10

To participate in this Assignment:

Week 10 Assignment

What’s Coming Up in Module 4?

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Next week, you will consider how evidence-based practice guidelines and ethical considerations factor into health assessments. You specifically explore evidence-based practice guidelines and ethical considerations for specific scenarios.

Week 11 Final Exam

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Next week, you take your Final Exam, which will cover the topics and resources from Weeks 7, 8, 9, and 10 for this course. Please take the time to review and plan your time accordingly so that you may be better prepared for your exam.

Next Module

To go to the next Module:

Module 4

Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal

One critical element of any physical exam is the ability of the examiner to put the patient at ease. By putting the patient at ease, nurses

are more likely to glean quality, meaningful information that will help the patient get the best care possible. When someone feels safe, listened to, and cared about, exams often go more smoothly. This is especially true when dealing with issues concerning breasts, genitals, prostates, and rectums, which are subjects that many patients find difficult to talk about. As a result, it is important to gain a firm understanding of how to gain vital information and perform the necessary assessment techniques in as non-invasive a manner as possible.

For this week, you explore how to assess problems with the breasts, genitalia, rectum, and prostate.

Learning Objectives

Students will:

• Evaluate abnormal findings on the genitalia and rectum
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the breasts, genitalia, prostate, and rectum

Learning Resources

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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 (9th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 17, “Breasts and Axillae”This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.

• Chapter 19, “Female Genitalia”In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia.

• Chapter 20, “Male Genitalia”The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.

• Chapter 21, “Anus, Rectum, and Prostate”This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 5, “Amenorrhea”
Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.

Chapter 6, “Breast Lumps and Nipple Discharge”
This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam.

Chapter 7, “Breast Pain”
Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.

Chapter 27, “Penile Discharge”
The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.

Chapter 36, “Vaginal Bleeding”
In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.

Chapter 37, “Vaginal Discharge and Itching”
This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies.

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

• Chapter 3, “SOAP Notes” (Previously read in Week 8)

Cucci, E., Santoro, A., DiGesu, C., DiCerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: Report of two cases and review of the literature. Polish Journal of Radiology, 80, 122–127. doi:10.12659/PJR.892706. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356184/  

Sabbagh , C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085. doi:10.1016/j.dld.2014.08.045

Westhoff , C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5–10.

This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.

Centers for Disease Control and Prevention. (2019). Sexually transmitted diseases (STDs). Retrieved from http://www.cdc.gov/std/#

 

This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.

Document: Final Exam Review (Word document)

Optional Resource

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

• Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)Section 2 of this chapter focuses on the anatomy and physiology of breasts. The section provides descriptions of breast examinations and common breast conditions.

• Chapter 11, “The Female Genitalia and Reproductive System” (pp. 541–562)In this chapter, the authors provide an overview of the female reproductive system. The authors also describe symptoms of disorders in the reproductive system.

• Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)The authors of this chapter detail the anatomy of the male reproductive system. Additionally, the authors describe how to conduct an exam of the male reproductive system.

• Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)

Required Media (click to expand/reduce)

Special Examinations – Breast, Genital, Prostate, and Rectal – Week 10 (14m)

Online media for Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 16 and 18–20 that relate to special examinations, including breast, genital, prostate, and rectal. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/

Sample Answer 2 for NURS 6512 Assessment of the genitalia and rectum Assignment

Assessment is one of the skills that nurses should possess in their practice. Nurses use their assessment knowledge and skills in developing accurate diagnoses and plans of care for their patients. The assessment skills that nurses often use in their practice include history taking and physical examination such as observation, palpation, percussion, and auscultation. Assessment results also guide the evaluation of care given to the patients. Nurses use evaluation information to determine the accuracy of their diagnoses, plans, and interventions used to address the care needs of their patients. Therefore, this paper is an examination of a case study of client who presented to the clinic with genitourinary problem. The client came with a history of external pumps in her genital area, which are painless and rough. The history obtained from her shows that she had the last pap smear test three years ago, which was normal. The patient does not have any significant medical, family or surgical history. Therefore, the paper examines the subjective and objective data that should be obtained for the patient, diagnostic investigations and differential diagnoses for the client.

Additional Subjective Data

The nurse should focus on obtaining additional subjective data from the patient besides those in the case snapshot. The additional subjective data will guide the development of accurate diagnosis and treatment plan for the client. The nurse should obtain the information about additional symptoms that are associated with the external pumps on her genitalia (Stephen & Skillen, 2020). The nurse should obtain information such as size, shape, any discharge, or changes in the pumps that might have occurred over the past in terms of appearance. The nurse should also obtain additional information about any history of similar pumps in the past. A history of closely related pumps of the genital area could guide the development of diagnoses such as warts in the patient. There is also the need for the nurse to obtain information related to medication use by the patient. A history of medication uses such as those used in managing the pumps could aid in determining the cause of the problem (Stephen & Skillen, 2020). History on medication use could also guide the determination of whether the pumps are attributable to side effects or adverse reactions to a drug.

Moreover, the nurse should obtain information about the use of any irritants in the past that might have caused the pump. For example, information about the types of soaps that the patient uses should be obtained. The client should also be asked about her sexual preferences. This will provide information about her sexual habits, which might have led to the development of the pumps. The effect of the pumps on the self-perception of the client should also be obtained. The nurse should try to rate the effect of the pumps on her self-image and self-esteem using an appropriate rating scale (Forbes & Watt, 2020). The additional subjective data that may be needed include history of skin problems such as eczema, menstrual history, and occupational history to determine any risk factors in her workplace place.

Additional Objective Data

Additional objective data should also be obtained from the client to increase the accuracy of the diagnosis. The nurse should have performed a rectal examination. The examination could have provided clues such as the presence of hemorrhoids or anal fissures. The nurse should have also provided information about the general appearance of the client. The general appearance could have provided clues on the social, emotional and physical impact of the pumps on the client (Cox, 2019). The nurse should have also performed head to toe examination of the client. The examination could have included the assessment of the skin to determine the existence of undetected skin lesions. The nurse should have also examined the oral cavity for any lesions, neck for inflamed lymph nodes and neck rigidity. The nurse should have also assessed the chest for any abnormal findings such as appearance, shape, or palpitations on auscultation (Champagne et al., 2017). The above information could have guided the accuracy of the diagnoses made by the nurse.

Whether Subjective and Objective Data Support the Assessment

The assessment is supported by subjective and objective data. Subjective data is the data that the patient provides concerning her experience with the health problem. The information is based on the perceived experiences by the patient and the management of the health problem. Subjective data provides the basis of assessment and physical examinations of the patient. The examples of subjective data that support the assessment include the client’s complaints, history of the complains, history of any vaginal discharge, her Pap smear examinations, and any significant past medical, surgical and family history. Objective data on the other hand is the data that the nurse obtains using assessment and physical examination techniques. The data is not based on the subjective experiences of the patient with the disease but the physiological changes in the patient due to the disease. Objective data is used to validate the subjective data (Perry et al., 2021). The examples of objective data in the case study include vital signs, auscultation of the heart and lungs and the observation of the genitalia. The diagnostic investigations that were ordered also form part of the objective data that supports the assessment.

Diagnostics

The development of accurate diagnosis of the client’s problem can be achieved by performing a number of diagnostic investigations. One of them is skin scrap. A scrap of the pumps can be obtained for laboratory examination. The other investigation is tzank smear to test for herpes simplex. The client should be tested for syphilis using diagnostics such as Darkfield microscopy or enzyme immunoassay (Perry et al., 2021).

Current Diagnosis

The current diagnosis of chancre is accurate. Patients with chancre present with symptoms similar to those of the client in the case study. For example, the ulcers are asymptomatic and can last for a period of up to six weeks (Cox, 2019).

Differential Diagnoses

One of the differential diagnoses that should be considered for the patient in the case study is contact dermatitis. Contact dermatitis is a skin condition that is characterized by symptoms such as the presence of rashes, which are dry, scaly and cracked. It is however the least likely due to the absence of itchiness and oozing or crusting of the rashes. The second differential diagnosis is syphilis. The client has a history of multiple sexual partners, which predisposes her to syphilis. Patients with syphilis also show skin rashes such as chancre in the early stages of syphilis. The last differential diagnosis is herpes simplex. Patients with herpes simplex may have symptoms such as rashes in the genitals

Conclusion

The diagnosis of chancre in the case study is accurate. Additional subjective and objective data should be obtained to come up with an accurate diagnosis. Differential diagnoses such as syphilis, herpes simplex, and contact dermatitis should however be considered. In addition, further diagnostic investigations should be performed to come up with an accurate diagnosis.

 

 

References

Champagne, B. J., Steele, S. R., Hendren, S. K., Bakaki, P. M., Roberts, P. L., Delaney, C. P., … & MacRae, H. M. (2017). The American Society of Colon and Rectal Surgeons assessment tool for performance of laparoscopic colectomy. Diseases of the Colon & Rectum, 60(7), 738-744.

Cox, C. L. (2019). Physical Assessment for Nurses and Healthcare Professionals. John Wiley & Sons.

DOI: https://doi.org/10.1097/DCR.0000000000000817

Forbes, H., & Watt, E. (2020). Jarvis’s Health Assessment and Physical Examination – E-Book: Australian and New Zealand. Elsevier Health Sciences.

Kohtz, C., Brown, S. C., Williams, R., & O’Connor, P. A. (2017). Physical assessment techniques in nursing education: a replicated study. Journal of Nursing Education, 56(5), 287-291. https://doi.org/10.3928/01484834-20170421-06

Perry, A. G., Potter, P. A., Ostendorf, W., & Laplante, N. (2021). Clinical Nursing Skills and Techniques—E-Book. Elsevier Health Sciences.

Stephen, T. C., & Skillen, D. L. (2020). Canadian Nursing Health Assessment. Lippincott Williams & Wilkins.

Sample Answer for NURS 6512 Assessment of the genitalia and rectum Assignment

Subjective Data

CC: “I have bumps on my bottom which I would like to be checked out.”

HPI: AB, a college student 21 years old WF came to the hospital complaining of external bumps on her genital area. She claims that the pumps feel rough and they are painless. She confirms being sexually active with multiple partners especially in the past years. She first encountered a sexual experience when she was 18 years old. She is quite not sure when the bumps started appearing but, she, however, came to notice them about a week before visiting the hospital. The last time she had a pap smear was three years ago, and the doctors did not find any dysplasia, as her results turned out to be normal. She, however, confirms only one sexually transmitted infection, chlamydia. She completed her treatment for chlamydia just as prescribed.

PMH: Asthma.

Medications: 160/4.5 mcg Symbicort

Allergies: No known drug or food allergies.

FH: She denies having a history of cervical or breast cancer. Her father had a history of HTN as well as her mother, together with GERD.

Social Hx: She denies ever using tobacco, but confirms using alcohol occasionally. She is married with three kids, I girl, and two boys.

Objective Data

VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

Heart: no murmurs, RRR

Lungs: CTA, symmetrical chest wall.

Genitalia: Hair distribution is normal around her genitalia with no swelling or masses. The urethral meatus is normal with no discharge or erythema. The perineum is normal, with a healed scare from her past episiotomy. Her vaginal mucosa is moist and pink with rugae present, pos for firm, small, round, and painless ulcer spotted on the external labia.

Abdominal: Normoactive bowel sounds, soft, neg murphy’s, neg rebound, neg McBurney.

Diagnostic: HSV specimen was obtained.

Assessment: Chancre.

Information Missing on the Subjective Data:

            For a substantial diagnosis, it is important for the nurse to gather as much subjective information as possible for a better understanding of the patient’s condition. For an instant, the history of presenting illness must also include a characteristic of the pumps that the patient is complaining about, in terms of color, size and pattern (In Passos, 2018). Whether they have been the same or changing ever since she noticed them. Moreover, whether she has done anything to try and get rid of them. Consequently, given that her condition is situated around the genitalia, and she was previously diagnosed of chlamydia, it is important to find out whether the patient has ever experienced symptoms of eczema and psoriasis in the past (In Passos, 2018). Her immunization status is also vital as part of the subjective data. The nurse must also get information from the patient regarding her past surgical history and her hospitalization status, and the reason for hospitalization if any. The past medical history should also include the drugs that the patient took to manage her chlamydia. The patient social history should include information such as whether she uses any contraceptives or sexual protection. The subjective portion should also include a review of system with information regarding weight gain weight loss, HEENT, skin assessment, breast assessment, genitourinary, cardiovascular, respiratory, musculoskeletal, hematological and neurological assessments.

Information Missing on the Objective Data

            The objective portion is the most crucial part of a patient’s history as it reports the findings upon physical examination. It should start with the vital signs of the patient, which have been included. However, BMI is missing. General information such as the patient’s conduct, alertness, grooming, and cleanliness should also be included. The HEENT portion should include information regarding her throat, tonsils, edema, drainage and whether there are lesions (In Passos, 2018). The neck should also be assessed for nodal tenderness or goiter. The chest region should be examined for non-labored breathing, nipple tenderness, and presence of breast nodules. The heart and the lung are also essential and information regarding whether the patient is experiencing wheezing, nasal flaring or retraction and heart rate, hear sounds, arrhythmias, and chest crackles should also be provided (In Passos, 2018). The genitourinary assessment should also include information regarding vaginal bleeding, vaginal discharge, frequency of the discharge and amount, and any abnormalities noted. The nurse should also conduct a rectal examination to check for lesions or masses.

Missing Diagnostic Tests

            The patient needs to have a full pelvic examination, which includes biopsy and pap smear for the nurse to be able to rule out other sexually transmitted infections. Enzyme immunoassay test should also be done to check for indications of syphilis and herpes. Her blood should also be screened for HIV. A urinalysis and HCG tests are also necessary given that the patient has an STD, and if pregnant, might affect the baby. An acetic acid test is also necessary to rule out genital warts (Kedar, Mukhi, Waghulkar, & Goyal, 2015). This test will also be able to rule out underlying reasons for HPV given that this woman has multiple sexual partners.

Assessment

            Both the subjective and objective data have supported the patient data assessment. For instance, from the subjective data, the nurse was able to know the patient’s presenting condition, the duration, past medical history, and other symptoms which are crucial to make a diagnosis. The objective data provides the results of physical information to confirm and more weight to the subjective data, hence being able to have an opinion of what the patient might be suffering from (In Passos, 2018). However, without the lab tests provided above, a final diagnosis cannot be made. For instance, chancroid is confirmed by the presence of painful open sores around the genital, whereas the patient complained of painless bumps, overruling it as a preferential diagnosis.

Differential Diagnosis

1. Syphilis: This is a sexually transmitted infection that is characterized by the presence of painless cores (chancre) around the genitalia in acute stages, which the patient is positive for. The infection can lie dormant in the patient’s body for several years. Syphilis mainly occurs in three stages; in the first stage, the patient will complain of having painful sore around her genital area, mouth or the bottom area, within the first ten days to three months of infection. The sores may get bigger with time. If untreated, the infection will progress to the second stage where the sores will disappear, and the patient might get rashes on her body, mostly on the palms of the hand and the soles of her feet. This stage is also accompanied by fever, headache, weight loss, hair loss and skin growth around the vulva (Klein, McLaud, & Rogers, 2015). The infection will then proceed to a latent stage before the third stage kicks in. The third stage is chronic infection where the condition might cause damage to the brain, nervous system and the heart.
2. Genital Herpes: This is a sexually transmitted disease that is normally caused by the herpes simplex virus. It is characterized by a cracked, raw and red area around the genitals which is usually painless. Other symptoms include itching and small blisters that break open with time causing pain, headache, backaches, painful urination and flue like symptoms (OʼByrne, MacPherson, Kitson, & Bourgault, 2019). It is usually asymptomatic among most patients at first. However, upon an early treatment, the patient will recover within a short time of medical therapy.
3. Genital Warts: This condition is sexually transmitted and mainly caused by certain types of HPV. They always appear on the skin around the genital area. This condition is mainly characterized by whitish or skin colored bumps on the vagina, vulva, cervix or the anus (OʼByrne, MacPherson, Kitson, & Bourgault, 2019). The bumps can either be big or small, one or numerous and sometimes painful or painless. Sometimes the patient might experience itchiness and bleeding from the genital area.
4. Molluscum Contagion: This is a common viral infection of the skin especially on the genitalia. Elevated, pearl-like nodules or papules characterize it. The papules are usually painless with no itchy feeling just like in the patient above. This condition does not leave scars (OʼByrne, MacPherson, Kitson, & Bourgault, 2019). Most of the time, this condition resolves on itself even without treatment.
5. Contact dermatitis: It is an allergic reaction that causes itchiness and redness of the skin; as a result to contact with an allergen. It is presented with symptoms such as red rash around the genitalia, dry, cracked and scaly skin, bumps and blisters that sometimes oozes, and swelling or burning sensation (Mowad et al., 2016).

References

In Passos, M. R. L. (2018). Atlas of sexually transmitted diseases: Clinical aspects and differential diagnosis. Cham, Switzerland: Springer.

Kedar, K., Mukhi, J., Waghulkar, R., & Goyal, M. (January 01, 2015). The risk assessment and predictive value of cytological smear and culture of vaginal discharge in reproductive age group women. Journal of Pakistan Association of Dermatologists, 25(4), 276-281.

Klein, J., McLaud, M., & Rogers, D. (January 01, 2015). Syphilis on the Rise: Diagnosis, Treatment, and Prevention. The Journal for Nurse Practitioners, 11(1), 49-55.

Mowad, C. M., Anderson, B., Scheinman, P., Pootongkam, S., Nedorost, S., Pootongkam, S., & Brod, B. (June 01, 2016). Allergic contact dermatitis Patient diagnosis and evaluation. Journal of the American Academy of Dermatology, 74(6), 1029-1040.

OʼByrne, P., MacPherson, P., Kitson, C., & Bourgault, A. (January 01, 2019). Consideration of sexually transmitted infections in the differential diagnosis: Case studies. Journal of the American Association of Nurse Practitioners, 31(1), 65-71.

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Content

Name: NURS_6512_Week_10_Assignment_Rubric

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		Excellent	Good	Fair	Poor
With regard to the SOAP note case study provided and using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature: ·   Analyze the subjective portion of the note. List additional information that should be included in the documentation.		Points Range: 10 (10%) – 12 (12%) The response clearly, accurately, and thoroughly analyzes the subjective portion of the SOAP note and lists detailed additional information to be included in the documentation.	Points Range: 7 (7%) – 9 (9%) The response accurately analyzes the subjective portion of the SOAP note and lists additional information to be included in the documentation.	Points Range: 4 (4%) – 6 (6%) The response vaguely analyzes the subjective portion of the SOAP note and vaguely and/or inaccurately lists additional information to be included in the documentation.	Points Range: 0 (0%) – 3 (3%) The response inaccurately analyzes the subjective portion of the SOAP note, with inaccurate and/or missing additional information included in the documentation.
·   Analyze the objective portion of the note. List additional information that should be included in the documentation.		Points Range: 10 (10%) – 12 (12%) The response clearly, accurately, and thoroughly analyzes the objective portion of the SOAP note and lists detailed additional information to be included in the documentation.	Points Range: 7 (7%) – 9 (9%) The response accurately analyzes the objective portion of the SOAP note and lists additional information to be included in the documentation.	Points Range: 4 (4%) – 6 (6%) The response vaguely analyzes the objective portion of the SOAP note and vaguely and/or inaccurately lists additional information to be included in the documentation.	Points Range: 0 (0%) – 3 (3%) The response inaccurately analyzes the objective portion of the SOAP note, with inaccurate and/or missing additional information included in the documentation.
·  Is the assessment supported by the subjective and objective information? Why or why not?		Points Range: 14 (14%) – 16 (16%) The response clearly and accurately identifies whether or not the assessment is supported by the subjective and/or objective information, with a thorough and detailed explanation.	Points Range: 11 (11%) – 13 (13%) The response accurately identifies whether or not the assessment is supported by the subjective and/or objective information, with a clear explanation.	Points Range: 8 (8%) – 10 (10%) The response vaguely identifies whether or not the assessment is supported by the subjective and/or objective information, with a vague explanation.	Points Range: 0 (0%) – 7 (7%) The response inaccurately identifies whether or not the assessment is supported by the subjective and/or objective information, with an inaccurate or missing explanation.
·   What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?		Points Range: 18 (18%) – 20 (20%) The response thoroughly and accurately describes appropriate diagnostic tests for the case and explains clearly, thoroughly, and accurately how the test results would be used to make a diagnosis.	Points Range: 15 (15%) – 17 (17%) The response accurately describes appropriate diagnostic tests for the case and explains how the test results would be used to make a diagnosis.	Points Range: 12 (12%) – 14 (14%) The response vaguely and/or with some inaccuracy describes appropriate diagnostic tests for the case and vaguely and/or with some inaccuracy explains how the test results would be used to make a diagnosis.	Points Range: 0 (0%) – 11 (11%) The response inaccurately describes appropriate diagnostic tests for the case, with an inaccurate or missing explanation of how the test results would be used to make a diagnosis.
·   Would you reject or accept the current diagnosis? Why or why not? ·   Identify three possible conditions that may be considered as a differenial diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.		Points Range: 23 (23%) – 25 (25%) The response states clearly whether to accept or reject the current diagnosis, with a thorough, accurate, and detailed explanation of sound reasoning. The response clearly, thoroughly, and accurately identifies three conditions as a differential diagnosis, with reasoning that is explained clearly, accurately, and thoroughly using three or more different references from current evidence-based literature.	Points Range: 20 (20%) – 22 (22%) The response states whether to accept or reject the current diagnosis, with an accurate explanation of sound reasoning. The response accurately identifies three conditions as a differential diagnosis, with reasoning that is explained using three different references from current evidence-based literature.	Points Range: 17 (17%) – 19 (19%) The response states whether to accept or reject the current diagnosis, with a vague explanation of the reasoning. The response identifies two to three conditions as a differential diagnosis, with reasoning that is explained vaguely and/or inaccurately using three or fewer references from current evidence-based literature.	Points Range: 0 (0%) – 16 (16%) The response inaccurately states or is missing a statement of whether to accept or reject the current diagnosis, with an explanation that is inaccurate and/or missing. The response identifies three or fewer conditions as a differential diagnosis, with reasoning that is missing or explained inaccurately using two or fewer references from current evidence-based literature.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.		Points Range: 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.	Points Range: 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.	Points Range: 3 (3%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.	Points Range: 0 (0%) – 2 (2%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation		Points Range: 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.	Points Range: 4 (4%) – 4 (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors.	Points Range: 3 (3%) – 3 (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors.	Points Range: 0 (0%) – 2 (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.		Points Range: 5 (5%) – 5 (5%) Uses correct APA format with no errors.	Points Range: 4 (4%) – 4 (4%) Contains a few (1 or 2) APA format errors.	Points Range: 3 (3%) – 3 (3%) Contains several (3 or 4) APA format errors.	Points Range: 0 (0%) – 2 (2%) Contains many (≥ 5) APA format errors.
Total Points: 100