NURS 6512 Assignment Neurological Symptoms
Walden University NURS 6512 Assignment Neurological Symptoms-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University  NURS 6512 Assignment Neurological Symptoms 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 Assignment Neurological Symptoms
Whether one passes or fails an academic assignment such as the Walden University  NURS 6512 Assignment Neurological Symptoms 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 Assignment Neurological SymptomsÂ
The introduction for the Walden University  NURS 6512 Assignment Neurological Symptoms 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 Assignment Neurological SymptomsÂ
After the introduction, move into the main part of the  NURS 6512 Assignment Neurological Symptoms 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 Assignment Neurological SymptomsÂ
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 Assignment Neurological Symptoms
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 Assignment Neurological Symptoms
HPI: J.K.L is a 40-year-old African American female who has been complaining of a headache across her forehead for a week. The headache is squeezing and feels like pressure behind the eyes. It does not emit radiation. The headache is constant and varies in severity from 2/10 to 8/10. It is usually worse in the morning and when bending. Acetaminophen reduces the severity of the headache to 4/10 and, on rare occasions, 2/10. It is characterized by fever, postnasal drip, nasal congestion, sneezing, and the occasional nonproductive cough. She takes Sudafed HCL 120 mg every 12 hours to get some relief. Her concentration at work has been significantly impaired, and she is extremely tired as a result of the symptoms. Finally, she reports a head cold three weeks ago.
Current Medications: Pseudoephedrine 120 mg BID for nasal congestion and acetaminophen for headaches.
Allergies: She has no known food and drug allergies.
Past Medical History: 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.
Social History: 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.
Family History: 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.
Sample Answer 2 for NURS 6512 Assignment Neurological Symptoms
Episodic/Focused SOAP Note
Patient Information:
Initials: N.T, Age: 46 years, Sex: Female, Race: White
S.
CC ” I have pain in both ankles”
HPI: N.T. is a forty-six-year-old white female patient who reported to the facility for a check. She complains of pain in both her ankles, even though she expresses more concern with the right ankle. The patient was playing soccer during the weekend when she heard a pop sound, which led to uncomfortable pain. The patient also experienced swelling following the pop sound. Consequently she is also unable to bear her weight. The pain is throbbing and more concentrated on the right ankle. She also rates the pain while resting. The pain is also radiating up the right lower extremity.
Current Medications: The patient is not using any medication currently.
Allergies: There are no records of allergies to food, medication, or environment.
PMHx: The patient indicated that she took her full dose of COVID-19. All other immunizations and annual flu tests are up to date.
Soc Hx: The patient is currently a single parent with three children. She works in the hotel industry. She likes playing soccer, which she does mostly during weekends but also occasionally in the evenings. She denies the previous or current use of alcohol. She also denies smoking or use of other illegal drugs.
Fam Hx: The patient’s parents are still alive; the father is eighty years old, and the mother is seventy-seven years old. The father is living with diabetes and hypertension while the mother has been treated for depression before and is currently living with osteoporosis. She has one elder brother and a younger sister and both are fairly healthy with no major health concerns.
ROS:
GENERAL: No fatigue, weakness, chills, fever, and weight loss.
HEENT: The patient’s head is normal; No visual loss, blurred vision, or double vision. She also denies reduced hearing, sneezing, congestion, sore throat, or even runny nose.
SKIN: No signs of rash, itching, or bruising.
CARDIOVASCULAR: No chest discomfort, chest pain, or pressure. Denies palpitations or edema.
RESPIRATORY: The patient denies any shortness of breath, sputum, or cough.
GASTROINTESTINAL: Â The patient denies anorexia, nausea, vomiting, or abdominal pain.
GENITOURINARY: Â No burning or pain during urination. She denies pregnancy. NEUROLOGICAL: She denies headache, dizziness, paralysis, ataxia, or numbness.
MUSCULOSKELETAL: She reports bilateral ankle pain. The pain is more concentrated on the right ankle as compared to the left ankle. She also reports swelling in the right ankle and is unable to bear her weight.
HEMATOLOGIC: No anemia or bleeding.
LYMPHATICS: Â No history of splenectomy; denies enlarged nodes.
PSYCHIATRIC: No history of headache or mental illness.
ENDOCRINOLOGIC: No Polydipsia or polyuria.
ALLERGIES: Â No known allergies, either to food, medication, or environment
O.
Physical exam:
Vital signs: BP: 116/75, Temp: 97.0, RR: 18, HR: 76, Height: 6.2, Weight: 141 lbs
General: The patient is well-dressed and groomed. She is alert and oriented. She appears concerned regarding her ankle pain which started after hearing a pop sound when playing soccer during the weekend.
HEENT: The head is atraumatic and Normocephalic. Â No ear pain or discharge. No loss of vision, no runny or stuffy nose. The patient’s neck is supple.
Skin: Â The skin is warm and dry, with no wounds and no skin rashes. Bruising was seen in the right lateral ankle.
Chest: The heartbeat and heart rate are both regular, with no gallops, murmurs, or extra sounds. No cough or dyspnea. The patient’s lungs are clear.
The musculoskeletal system: The patient’s right ankle has bruises, and the fibula’s lower aspects are tender upon palpation. Less motion range was observed in the ankles. The swelling was also observed. Pain experienced on the leg when bearing weight. The left ankle had no bruising, swelling, or tenderness.
Diagnostic results: The Ottawa Ankle rule is to be used to help determine if the patient needs an X-ray to confirm or rule out a fracture (Morais et al.,2021). Ultrasound can be conducted to assess the structure of the soft tissues such as ligaments and tendons.
Differential Diagnoses
- An Ankle sprain: This is a condition which usually occurs when the ligaments supporting a person’s ankle are torn or stretched. In most cases, the foot can forcefully turn outward or inward. Ankle sprains are known to be common when individuals participate in activities such as soccer and go for a sudden directional change (Halabchi & Hassabi, 2020). The condition can have varied severity, usually from mild to severe. This condition may present with various symptoms, such as finding it difficult to walk, joint stiffness, soreness, bruising, swelling, and pain. The patient was playing soccer when she heard a pop sound, leading to pain and swelling in her right ankle. The patient showed several of these symptoms which makes an ankle sprain one of the diagnoses.
- Achilles tendonitis: This is a condition that may present with pain and discomfort due to tendon injuries like a tear or inflammation. The condition is sometimes known as Achilles tendinitis. In most cases, the illness may come due to a repetitive strain or overuse of the Achilles tendon, which then makes a patient to experience swelling and pain. It can also result due to weak or tight calf muscles which is known to lead to higher strain on the Achilles tendon. Other causes include a sudden increase in physical activity which can be characterized by an increased frequency, duration or intensity of the physical exercise or activity that a person engages in. Some of the symptoms include pain in the back of a person’s leg, pain exacerbated with activity, a stiff Achilles tendon, and swelling (Touzell, 2020). In addition, a patient may experience a mild thickening of the tendon, tenderness and a significant reduced range or motion. Â The patient heard a pop sound when playing soccer, which makes this condition suspect.
- Chronic Ankle Instability: This is a condition that may result from multiple cases of ankle sprains, which then makes the patient prone to injuries. This condition may present with various symptoms such as ankle instability, injuries, swelling, pain, and re-injuries for more than half a year (Herzog et al.,2019). The patient may also experience recurrent sprains, complications maintaining balance and feelings of giving away. The condition is also known to substantially impact a persons, stability, mobility and the overall quality of life. The patient reported some of these symptoms, which makes this condition to be a potential diagnosis. However, the patient has no history of incomplete healed ligaments, which again makes this condition less likely.
- Ankle fracture: This is a condition that entails cracking or breaking of one or more of the bones which make up the ankle joint. It can occur in either the talus, fibula or tibia. Ankle fracture may happen when a person experiences events such as an awkward landing or forceful impact. The condition can also be caused by osteoporosis which causes the bones to weaken, hence exposing the person to the condition. Sudden rolling or twisting of the ankle with force can also lead to this condition. Consequently, a person may put stress on the ankle, leading to the condition. Some of the symptoms include complications bearing weight, bruising, and swelling (Briet et al.,2019). Other symptoms may also include misalignment or deformity of the ankle and pain. The patient presented with some of these symptoms, making this a potential diagnosis.
- Muscle soreness: Muscle soreness can be experienced after an individual takes part in physical activity or exercise. The condition is sometimes known as a delayed onset of muscle soreness. The condition is in most cases experienced when an individual takes part in physical exercise or activity that entail the eccentric muscle contraction, or lengthening of the muscle under tension. In addition, it is known to typically begin twenty four hours to forty eight hours after an exercise can have its peak around seventy two hours. The patient may experience reduced flexibility and strength and pain or discomfort in the skeletal muscles (Heiss et al.,2019). Other symptoms may include muscle discomfort, tenderness and stiffness. An individual with the condition may also experience an exacerbation of the soreness when the affected muscles are stretched or moved. The patient experienced pain when playing soccer, which makes this a potential diagnosis.
References
Briet, J. P., Hietbrink, F., Smeeing, D. P., Dijkgraaf, M. G., Verleisdonk, E. J., & Houwert, R. M. (2019). Ankle fracture classification: an innovative system for describing ankle fractures. The Journal of Foot and Ankle Surgery, 58(3), 492-496. https://doi.org/10.1053/j.jfas.2018.09.028
Halabchi, F., & Hassabi, M. (2020). Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World Journal of Orthopedics, 11(12), 534. https://doi.org/10.5312%2Fwjo.v11.i12.534
Heiss, R., Lutter, C., Freiwald, J., Hoppe, M. W., Grim, C., Poettgen, K., … & Hotfiel, T. (2019). Advances in delayed-onset muscle soreness (DOMS)–part II: treatment and prevention. Sportverletzung· Sportschaden, 33(01), 21-29. DOI: 10.1055/a-0810-3516
Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. (2019). Epidemiology of ankle sprains and chronic ankle instability. Journal of Athletic Training, 54(6), 603-610. https://doi.org/10.4085/1062-6050-447-17
Morais, B., Branquinho, A., Barreira, M., Correia, J., Machado, M., Marques, N., … & Diogo, N. (2021). Validation of the Ottawa ankle rules: Strategies for increasing specificity. Injury, 52(4), 1017-1022. https://doi.org/10.1016/j.injury.2021.01.006
Touzell, A. (2020). The Achilles tendon: Management of acute and chronic conditions. Australian Journal of General Practice, 49(11), 715–719. Doi: 10.3316/INFORMIT.553809190362672.
Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6512 Assignment Neurological Symptoms
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.
In this Case Study Assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.
To Prepare
• By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
• 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.
With regard to the case study you were assigned:
• Review this week’s Learning Resources, and consider the insights they provide about the case study.
• Consider what history would be necessary to collect from the patient in the case study you were assigned.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Case Study Assignment
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.
By Day 6 of Week 9
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 “WK9Assgn1+last name+first initial.(extension)” as the name.
• Click the Week 9 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 9 Assignment 1 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 “WK9Assgn1+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 9 Assignment 1 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 9 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 6 of Week 9
To participate in this Assignment:
Week 9 Assignment 1
Week 9: Assessment of Cognition and the Neurologic System
A 63-year-old woman comes to your office because she’s been forgetting things…a young mother comes in concerned because her baby fails to make eye contact and is unresponsive to touch…a teenager comes in and a parent complains that the teen obsessively washes his hands.
An array of neurological conditions could be causing the above symptoms. When assessing the neurologic system, it is vital to formulate an accurate diagnosis as early as possible to prevent continued damage and deterioration of a patient’s quality of life.
This week, you will explore methods for assessing the cognition and the neurologic system.
Learning Objectives
Students will:
• Evaluate abnormal neurological symptoms
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for cognition and the neurologic system
• Assess health conditions based on a head-to-toe physical examination
________________________________________
Also Read:
NURS 6512 Assignment 3: Digital Clinical Experience: Comprehensive (Head-to-Toe) Physical Assessment
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NURS 6512 Assignment Ethical Concerns
NURS 6512 Week 9 Assessment Of Cognition And The Neurologic System
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NURS 6512 Digital Clinical Experience
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NURS 6512 Episodic/Focused SOAP Note Template
NURS 6512 Discussion Episodic/Focused SOAP Note
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NURS 6512 Research the health-illness continuum and its relevance to patient care
NURS 6512 discuss the relevance of the continuum to patient care
NURS 6512 Cultural and linguistic competence
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Learning Resources
Required Readings (click to expand/reduce)
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 7, “Mental Status”
This chapter revolves around the mental status evaluation of an individual’s overall cognitive state. The chapter includes a list of mental abnormalities and their symptoms.
• ·Chapter 23, “Neurologic System”
The authors of this chapter explore the anatomy and physiology of the neurologic system. The authors also describe neurological examinations and potential findings.
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 4, “Affective Changes”
This chapter outlines how to identify the potential cause of affective changes in a patient. The authors provide a suggested approach to the evaluation of this type of change, and they include specific tools that can be used as part of the diagnosis.
Chapter 9, “Confusion in Older Adults”
This chapter focuses on causes of confusion in older adults, with an emphasis on dementia. The authors include suggested questions for taking a focused history as well as what to look for in a physical examination.
Chapter 13, “Dizziness”
Dizziness can be a symptom of many underlying conditions. This chapter outlines the questions to ask a patient in taking a focused history and different tests to use in a physical examination.
Chapter 19, “Headache”
The focus of this chapter is the identification of the causes of headaches. The first step is to ensure that the headache is not a life-threatening condition. The authors give suggestions for taking a thorough history and performing a physical exam.
Chapter 31, “Sleep Problems”
In this chapter, the authors highlight the main causes of sleep problems. They also provide possible questions to use in taking the patient’s history, things to look for when performing a physical exam, and possible laboratory and diagnostic studies that might be useful in making the diagnosis.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
• Chapter 2, “The Comprehensive History and Physical Exam” (“Cranial Nerves and Their Function” and “Grading Reflexes”) (Previously read in Weeks 1, 2, 3, and 5)
Note: Download the Physical Examination Objective Data Checklist to use as you complete the Comprehensive (Head-to-Toe) Physical Assessment assignment.
Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical examination objective data checklist. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Mosby’s Guide to Physical Examination, 7th Edition by Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2011 by Elsevier. Reprinted by permission of Elsevier via the Copyright Clearance Center.
Note: Download and review the Student Checklists and Key Points to use during your practice neurological examination.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Neurologic system: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Neurologic system: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Mental status: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Bearden , S. T., & Nay, L. B. (2011). Utility of EEG in differential diagnosis of adults with unexplained acute alteration of mental status. American Journal of Electroneurodiagnostic Technology, 51(2), 92–104.
This article reviews the use of electrocenographs (EEG) to assist in differential diagnoses. The authors provide differential diagnostic scenarios in which the EEG was useful.
Athilingam, P ., Visovsky, C., & Elliott, A. F. (2015). Cognitive screening in persons with chronic diseases in primary care: Challenges and recommendations for practice. American Journal of Alzheimer’s Disease & Other Dementias, 30(6), 547–558. doi:10.1177/1533317515577127
Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6512 Assignment Neurological Symptoms
Sinclair , A. J., Gadsby, R., Hillson, R., Forbes, A., & Bayer, A. J. (2013). Brief report: Use of the Mini-Cog as a screening tool for cognitive impairment in diabetes in primary care. Diabetes Research and Clinical Practice, 100(1), e23–e25. doi:10.1016/j.diabres.2013.01.001
Roalf, D. R., Moberg, P. J., Xei, S. X., Wolk, D. A., Moelter, S. T., & Arnold, S. E. (2013). Comparative accuracies of two common screening instruments for classification of Alzheimer’s disease, mild cognitive impairment, and healthy aging. Alzheimer’s & Dementia, 9(5), 529–537. doi:10.1016/j.jalz.2012.10.001. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036230/
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us
Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)
Document: DCE (Shadow Health) Documentation Template for Comprehensive (Head-to-Toe) Physical Assessment (Word document)
Use this template to complete your Assignment 3 for this week.
Optional Resources
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
• Chapter 14, “The Neurologic Examination” (pp. 683–765)
This chapter provides an overview of the nervous system. The authors also explain the basics of neurological exams.
• Chapter 15, “Mental Status, Psychiatric, and Social Evaluations” (pp. 766–786)
In this chapter, the authors provide a list of common psychiatric syndromes. The authors also explain the mental, psychiatric, and social evaluation process.
Mahlknecht, P., Hotter, A., Hussl, A., Esterhammer, R., Schockey, M., & Seppi, K. (2010). Significance of MRI in diagnosis and differential diagnosis of Parkinson’s disease. Neurodegenerative Diseases, 7(5), 300–318.
Required Media (click to expand/reduce)
Neurologic System – Week 9 (16m)
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 7 and 23 that relate to the assessment of cognition and the neurologic system. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Content
Name: NURS_6512_Week_9_Assignment1_Rubric
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• List View
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Using the Episodic/Focused SOAP Template:
· Create documentation or an episodic/focused note in SOAP format about the patient in the case study to which you were assigned.
· Provide evidence from the literature to support diagnostic tests that would be appropriate for your case. Points Range: 45 (45%) – 50 (50%)
The response clearly, accurately, and thoroughly follows the SOAP format to document the patient in the assigned case study. The response thoroughly and accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study. Points Range: 39 (39%) – 44 (44%)
The response accurately follows the SOAP format to document the patient in the assigned case study. The response accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study. Points Range: 33 (33%) – 38 (38%)
The response follows the SOAP format to document the patient in the assigned case study, with some vagueness and inaccuracy. The response provides evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study, with some vagueness or inaccuracy in the evidence selected. Points Range: 0 (0%) – 32 (32%)
The response incompletely and inaccurately follows the SOAP format to document the patient in the assigned case study. The response provides incomplete, inaccurate, and/or missing evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.
· List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each. Points Range: 30 (30%) – 35 (35%)
The response lists five distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study and provides a thorough, accurate, and detailed justification for each of the five conditions selected. Points Range: 24 (24%) – 29 (29%)
The response lists four to five different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the five conditions selected. Points Range: 18 (18%) – 23 (23%)
The response lists three to four possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or some inaccuracy in the conditions and/or justification for each.
Points Range: 0 (0%) – 17 (17%)
The response lists three or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.
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.
Sample Answer 2 for NURS 6512 Assignment Neurological Symptoms
Patient Information:
A.Y, 20 year-old African American male
S.
CC “I have been experiencing intermittent headaches that diffuse all over the head with greatest intensity and pressure above the eyes.”
HPI: The patient came with complaints of intermittent headaches for the last one week. The headaches diffuse all over the head with greatest intensity and pressure above the eyes and spreads through the nose, cheekbones, and jaw. The client reports that analgesics such as acetaminophen provide him with relieve that is not long lasting. The associated symptoms include nausea and photophobia. The severity of pain as reported by the patient was 8/10.
Current Medications: The patient has been using acetaminophen 1 gm TDS for the last four days.
Allergies: The client denied any food, drug, or environmental allergy.
PMHx: The client’s immunization history is up to date.
Soc Hx: The client is a college student undertaking a degree in information technology. He does not smoke or take alcohol. He engages in active physical activity, as he is a member of the university basketball team. His social support comprises of his family members and friends.
Fam Hx: The client denied any chronic illnesses in the family.
ROS:
GENERAL: Â The patient appeared well-groomed for the occasion without any signs of malaise or weight loss. He denied fever and chills.
HEENT: Â Eyes: The client denied visual loss, blurred vision, double vision or yellow sclerae. He reported photophobia during the episodes of intermittent headaches.
Ears, Nose, Throat: Â He denied hearing loss, sneezing, congestion, runny nose or sore throat.
SKIN: Â He denied rash, scars, or itching.
CARDIOVASCULAR: Â He denied chest pain, chest pressure, chest discomfort, palpitations or edema.
RESPIRATORY: Â He denied shortness of breath, difficulty in breathing, cough or sputum.
GASTROINTESTINAL: Â Denies anorexia, vomiting or diarrhea. He also denied abdominal pain or blood. He reported nausea during episodes of intermittent headaches.
GENITOURINARY: Â He denied burning on urination, increased urinary frequency, or changes in smell and color of urine.
NEUROLOGICAL: Â The patient reports intermittent headaches, denies syncope, dizziness, paralysis, numbness, and tingling of the extremities. He also denied changes in bladder and bwel control.
MUSCULOSKELETAL: Â The patient denied muscle, back pain, joint pain or stiffness.
HEMATOLOGIC: Â He denied anemia, bleeding or bruising.
LYMPHATICS: Â He denied enlarged nodes with absence of a history of splenectomy.
PSYCHIATRIC: Â He denied history of depression or anxiety.
ENDOCRINOLOGIC: Â He denied history of sweating, cold or heat intolerance. He also denied polyuria or polydipsia.
ALLERGIES: Â He denied history of asthma, hives, eczema or rhinitis.
O.
Physical exam:
General: The patient appears well groomed, with lack of evidence of weight loss and fatigue
Vitals: Temp 36.7, BP 122/76 P-80, RR 20, SPO2 96,
Head: normocephalic, with no lesions, evidence of trauma, with symmetric facial features. The maxillary and frontal sinuses are tender on palpation.
Ears: The ears are symmetric with absence of ear drainage, loss of balance, and grey tympanic membranes
Eyes: the eyes are symmetric, without jaundice and bleeding. Normal visual acuity
Nose: Absence of nasal flaring, discharge, and septum deviation
Throat: Absence of tonsillitis
Neck: symmetric trachea noted with absence of neck rigidity, swelling, and gross abnormalities of the thyroid
Cardiovascular: presence of S1 and S2, with absence of peripheral edema and advantageous sounds
Gastrointestinal: Absence of abdominal swelling, scars, with normal bowel movements.
Respiratory: Lung sounds clear with absence of advantageous sounds
Neurological: Client is oriented to self, place, time, and events. Pupil reactive to light and equal in size with equal grip in both hands and symmetrical facial features. The self-reported headache is rated at 8/10. There is the presence of intermittent headache, photophobia, and nausea.
Diagnostic results: One of the recommended diagnostic investigations that should be performed for the client is nasal scrapping. Nasal scraping should be performed to obtain a sample for test for esinophils. Radiological investigations are also recommended in case of severe symptoms. The investigations include a head CT scan to detect any abnormalities such as tissue involvement, inflammation of the meninges, and tumors. A MRI may also be done to determine the presence of any abnormality in the brain tissue and soft tissue pathology. Bacterial sinusitis may also be diagnosed by performing sinus aspiration (Iskandar & Triayudi, 2020).
A.
Differential Diagnoses
Sinusitis: The first differential diagnosis for the client in this case study is sinusitis. Sinusitis is a condition characterized by the inflammation of the nasal cavities. The symptoms often last for a period of less than a month. Patients with sinusitis experience symptoms that include frontal headaches with feelings of fullness. Patients also experience other accompanying symptoms that include nausea, vomiting, photophobia, and nasal drainage. The physical assessment findings may reveal tenderness of the sinuses (Iskandar & Triayudi, 2020). The patient in the case study has symptoms that align with this diagnosis, hence, it being the primary diagnosis.
Migraine headache: migraine headache is the secondary diagnosis for the patient in this case study. Patients with migraine headache experience severe, throbbing headache. The accompanying symptoms include photophobia, phonophobia, nausea, and vomiting (Ha & Gonzalez, 2019). This is however a least diagnosis because of the patient experiencing feelings of fullness and involvement of the sinuses.
Allergic rhinitis: The other possible diagnosis for the client is allergic rhinitis. Patients with allergic rhinitis experience symptoms that include headaches, nasal drainage, coughing, sneezing, and pressure on the cheeks and nose (Scadding et al., 2017). Allergic rhinitis is however the least likely diagnosis due to the absence of a history of allergic reaction by the client.
Facial pain syndrome: Facial pain syndrome is the other potential diagnosis for the client in the case study. Facial pain syndrome is attributed to pain affecting the trigeminal nerve. The symptoms associated with it include pain on touching the face, speaking, chewing or brushing teeth (Benoliel & Gaul, 2017). Facial pain syndrome is however the least likely diagnosis due to the absence of pain upon stimulation of the facial muscles.
Acute bacterial pharyngitis: Acute bacterial pharyngitis is the last potential diagnosis for the client. Acute bacterial pharyngitis is attributed to step bacterial infection. Patients experience symptoms that include difficulty in swallowing, headache, chills, and malaise. The patient however does not experience difficulty in swallowing, fever, and chills, hence, acute bacterial pharyngitis not being the primary differential (Harberger & Graber, 2021).
This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
References
Benoliel, R., & Gaul, C. (2017). Persistent idiopathic facial pain. Cephalalgia, 37(7), 680–691. https://doi.org/10.1177/0333102417706349
Ha, H., & Gonzalez, A. (2019). Migraine Headache Prophylaxis. American Family Physician, 99(1), 17–24.
Harberger, S., & Graber, M. (2021). Bacterial Pharyngitis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK559007/
Iskandar, A., & Triayudi, A. (2020). Early Diagnosis of Sinusitis Using Expert System Methods: Early Diagnosis of Sinusitis Using Expert System Methods. Jurnal Mantik, 4(2), 1231–1236. https://doi.org/10.35335/mantik.Vol4.2020.927.pp1231-1236
Scadding, G. K., Kariyawasam, H. H., Scadding, G., Mirakian, R., Buckley, R. J., Dixon, T., Durham, S. R., Farooque, S., Jones, N., Leech, S., Nasser, S. M., Powell, R., Roberts, G., Rotiroti, G., Simpson, A., Smith, H., & Clark, A. T. (2017). BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clinical & Experimental Allergy, 47(7), 856–889. https://doi.org/10.1111/cea.12953
Sample Answer for NURS 6512 Assignment Neurological Symptoms
Patient’s Bio-data
Initials: J.C
Age: 20 years
Sex: Male
Race/Ethnicity: African American
Chief Complaints
Headache
History of Presenting Illness: The patient complains of headaches that began one week ago. The headaches are diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones and the jaw. It is intermittent and occurs at regular intervals, the timing is varied as it can occur at any time of the day. The patient reports associated signs and symptoms including mild fever, photophobia, vomiting, sneezing and occasional insomnia due to the headache. He further reports that he is under a lot of pressure from events at school. Physical activities do not aggravate it. The patient takes acetaminophen which only provides a transient relief from the headache. He rates the severity of the headache to be 6/10.
Current Medications: He has been on acetaminophen 1000 mg PO per day for the last 4 days. He reports other days he takes 400 mg Ibuprofen PO 6 hourly. He however reports lack of a significant relief
Allergies: There is no significant food, drug or environmental allergies
Past Medical/Surgical History: The patient reports past medical admission due to pneumonia 5 months ago which was treated using antibiotics. He however reports that he attained recovery without finishing the dosage. There is no significant surgical history. All immunizations are up to date and the last tetanus booster shot was 2015.
Social History: J.C is a 2nd year student at a local university pursuing civil engineering as a course. Having passed his 12th grade exams, his dad persisted that he must pursue the cause despite him wanting to do IT related courses. He often whines and worried about the course being hard with a lot of reading and frequent difficult exams. Due to this, he indulges in binge drinking as a way of mitigating the stressful life events he goes through. He does not smoke. He stays at school’s hostels and come back home during holidays.
Family History: Both the mother and father are alive. He is the first born in a family of o4 children. There is no history of chronic illnesses in the family. The father is a retired engineer and the mother works at an auto insurance company.
Review of System:
General: Slight weight loss in the past few months, fever
HEENT: Eyes: photophobia but no blurring of visions. Ears, Nose and Throat: No hearing problems. Positive for sinus headaches and sneezing. No sore throat
Cardiovascular: Negative for orthopnea, paroxysmal nocturnal dyspnea. Occasional palpitations are present
Respiratory: intermittent dyspnea on exertion is present. No hemoptysis or coughs
Gastrointestinal: Positive for vomiting. No diarrhea or abdominal pain
Genitourinary, musculoskeletal, hematologic and all other systems are essentially normal.
Objective
Vital signs: BP 121/82; Pulse 88 b/min; Respiratory rate 22b/min; Temperature 37.8°C, SaO2  98%.
General: The patient is in a fair general condition, restless and sweating profusely. He is not in any obvious respiratory distress. He looks mildly dehydrated. There is no pallor, no lymphadenopathy, no jaundice, no cyanosis, no clubbing, no edema and no obvious deformity and skin changes.
Physical Examination
Neurological: On assessment of the level of consciousness, the patient scores a GCS of 14, E-4; V-4; M-6. A verbal score of 4 refers to a confused conversation. Additionally, a score betwixt 13-15 indicates mild coma. He is oriented in time, person and place. His memory is intact, no speech abnormality. Examination of the cranial nerves II-XI reveals no abnormality. Assessment of the motor system reveals muscles are of normal bulk and normal tone (no hypotonia or hypertonia). Using the MRC scale, the muscle power is 4 (moves against gravity and some resistance). Superficial reflexes and deep tendon reflexes are intact. Assessment of the sensory system reveals no abnormality.
Cardiovascular: PMI is felt at the first intercostal space mid clavicular line. S1 and S2 sounds are heard with no additional sounds.
Respiratory: Bilateral symmetrical expansion of the lungs. Lungs are clear on percussion and auscultation
Gastrointestinal: The abdomen is symmetrical without distension, it moves with respiration, no obvious masses or skin changes. On palpation, no tenderness and masses revealed. Produce a resonant sound on palpation. Bowel sounds are present on auscultation
Work Ups
The first and foremost consideration in the differential diagnosis regarding J.C symptoms (headaches, mild fever, photophobia) is acute bacterial meningitis. As a result, the following tests are highly considered. Lumber puncture should be promptly performed. Examination of cerebrospinal fluid is the cornerstone of diagnosis. Diagnosis is made by culture of the CSF sample. Opening pressures are measured, cell count and differential count is done, and CSF chemistry (glucose and protein) and microbiology (Gram stain and culture) are done (Hasbun 2019). Additionally, a complete blood count with differentials and blood culture as well is necessary. Chest X-Ray is done to detect lung infections. Of note, the patient suffered from pneumonia 5 months ago when he attained a significant improvement without finishing his antibiotic dosage. There is a possibility of a relapse infection which has spread to the meninges to cause meningitis. The patient does not qualify to be a candidate of head CT scan. These indications include GSC of <15 at 2 hours after the injury, signs of basal skull fracture or lateralizing signs in the presence of an injury (American College of Radiologists, 2015). There is no significant reported injury in J.S’s case. Nasal cytology examination is useful to elucidate allergic rhinitis and eosinophilia
Assessment
           Various factors are to be considered in the diagnosis of J.C. Among those factors include the signs and symptoms, physical examination, his binge drinking and stressful life events. Based on these, the impression, differentials and justification are provided below.
Differentials
Acute bacterial meningitis: The signs and symptoms include headaches, fever, neck stiffness, and photophobia. J.C does not however have stiff neck. There can be signs of increased intracranial pressures such as vomiting, papilledema and lateralizing signs. J.C reports to have vomiting. Furthermore, vital sign examination reveals fever of 37.8°C; this is highly suggestive of an infection. In support of the diagnosis, he had pneumonia 5 months ago which he did not adhere to recommended dosage of antibiotics therefore a relapse of the infection is possible spreading to the meninges. Again, he engages in binge drinking, and according to Veen, Brouwer, Ende and Beek (2017), alcoholics are more prone to getting bacterial meningitis. Presence of leukocytosis and specific bacteria on CSF/blood culture are important to make the diagnosis.
Tension Type Headache: This type of headache is usually associated with stressful life events. It is evident from the case scenario that J.C is experiencing stressful events, having been forced to pursue his course. He often whines of the course being hard and the difficult exams. This is the reason for his binge drinking. In reference to Blanda (2017), the diagnostic criteria for TTH include intermittent/episodic headaches, not aggravated by physical activities; photophobia or phonophobia might be present, and it occurs under emotional stress or intense worry. Insomnia is often a characteristic. Based on J.C’s symptoms, the diagnosis qualifies him
Sinusitis: The patient reports sinus headaches on review of systems. Associated symptoms included sneezing. He reports pressure occurs through the eye and spreads through the nose. Furthermore, fever is highly suggestive of an infection making sinusitis a possibility.
Generalized anxiety disorder: Criteria for diagnosis of GAD as provided by American Psychiatric Association [APA] (2016) include presence of anxiety and increased worry (J.C is uneasy doing his course and repeatedly worry about the difficult exam), the worry is accompanied by edginess or restlessness (J.C is noted to be restless during the general examination), difficulty sleeping (he reports occasional insomnia), increased muscle aches, soreness or headaches (he has headaches). Anxiety patients have a disposition for substance abuse (APA, 2016). It is believed that alcohol reduce stress and fears. J.C’s main reason for drinking is to alleviate his stress
Encephalitis is also a potential differential diagnosis. Signs and symptoms include fever, headaches, nausea and vomiting. Photophobia and altered mental status are also common findings. Focal neurologic symptoms are common in encephalitis which is not quite evident in J.C’s case. That does not however rule it out as a differential
References
American College of Radiologists. (2015). Diagnostic CT scana-Head imaging. Radiology 235 (3), 741-751, 2005.
American Pshichiatrist Association. (2016). Diagnostic and Statistical Mnaual of Mental Disorders (5th ed). New Library.
Blanda, M. (2017, November 21). Tension Headache. Retrieved August 3, 2020, from Medscape: https://emedicine.medscapoe.com/article/792384-overview
Hasbun, R. (2019, July 6). Meningitis. Retrieved August 3, 2020, from Medscape: https://emedicine.medscape.com/article/232915-overview
Veen, K. E., Brouwer, M. C., Ende, A. V., & Beek, D. v. (2017). Bacterial meningitis in alcoholic patients: a population based prospective study. Journal of Infection 74 (4), 352-357, 2017.