NRSG 355 9.2009
NRSG 355 HEALTH ASSESSMENT and
PATHOPHYSIOLOGY
Bachelor of Science in Nursing
Spiritual
CONTRIBUTORS
Spiritual
Growth
The following
individuals contributed
Moral
Service
Patricia A. Niels
Dr. Lisa Evoy-Unger, December 2005 and May 2003
Personal
Growth
Personal
Change
Agent
Professional
Growth
ONU
Nurse
Leader
Professional
Life-Long
Learner
1
NRSG 355 9.2009
CONTRIBUTORS
The following individuals contributed to the completion of this course of study:
Patricia A. Nielsen, Assistant Professor of Nursing
Olivet Nazarene University
November 2007
2
NRSG 355 9.2009
NRSG 355 HEALTH ASSESSMENT AND PATHOPHYSIOLOGY
Statement of Faith
“As an educational enterprise of the Church of the Nazarene, we
pursue truth in order to glorify the God and the Father of our Lord
Jesus Christ: praying for the coming of the spirit; remembering
the promise of Scripture and tradition; keeping our hearts
faithfully attuned to the voice of God; and being thoughtfully,
acutely, and critically engaged.” 2002-2004 Catalog.
Bourbonnais, IL: Olivet Nazarene University.
COURSE DESCRIPTION/OVERVIEW
The focus of this course is to strengthen physical assessment knowledge through the
understanding of selected pathophysiological processes. Emphasis is placed on the concepts of
cellular injury, inflammation, hypoxia, and cancer, as well as the health continuum, the nursing
history, examination, and interviewing techniques, and documentation.
COURSE LEARNING OUTCOMES
Upon completion of this course, the learner will be able to:







Recognize the pathogenesis that can occur from cellular injury, inflammation,
hypoxia, and cancer.
Differentiate adaptive from maladaptive compensations in selected disease
processes.
Correlate pathophysiological processes with common manifestations notable
during physical assessment.
Recognize differences in the physiological effects of normal aging and disease in
the adult and the elderly.
Utilize effective communication skills in the development of a trusting and
cooperative relationship with a client.
Collect, interpret, and condense all assessment data and write it in an organized
past history, history of present illness, and review of systems.
Teach forms of healthcare prevention when risk factors or physical findings are
discovered.
COURSE MATERIALS
Required Textbooks:
American Psychological Association. (2001). Publication manual of the American Psychological
Association (5th ed.). Washington, DC: America Psychological Association.
Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th
ed.). St. Louis: Mosby, Inc.
3
NRSG 355 9.2009
Course Textbooks, articles, and access to blackboard will be made available to the learner.
Assignments may include discussion topics, individual assignments, and projects. Specifics are
outlined in the course syllabus.
Special Requirements:
Internet Access
Microsoft Office 2007 Software
Completion of the Online Blackboard Training Student Classroom is required.
COURSE ASSIGNMENTS/ASSESSMENTS
The learning outcomes will be fostered and assessed in a variety of ways. As best practice
suggests, assessment will be formative and summative and will include the application of
acquired course knowledge to real world practice settings. This course will include the
following:
WEEKLY DISCUSSION POSTINGS
WRITTEN ASSIGNMENTS
CUMULATIVE PORTFOLIO
Assignments
Points
Discussion
The discussion assignments each week may be online or on
ground
(Refer to the class instructor for discussion preference if not an
online course)
6 @ 5 points
each week
30
Discussion Rubric is applicable for either online or on ground
participation requirements
Assessment and Pathophysiology Paper
DUE Week 4 - Day 3
35
35
Assessment and Pathophysiology PPT
DUE Week 6 - Day 3
35
35
TOTAL COURSE POINTS
100
4
NRSG 355 9.2009
WEEKLY WORKSHOP TOPICS
WEEK 1:
WEEK 2:
WEEK 3:
WEEK 4:
WEEK 5:
WEEK 6:
ASSESSMENT INTERVIEW AND TECHNIQUES
RESPIRATORY SYSTEM
CIRCULATORY SYSTEM
NEUROLOGICAL AND MUSCKULOSKELETAL SYSTEM
DISCUSS THE NEUROLOGICAL ASSESSMENTCASE
SCENARIO
COMPLETE A NURSING HISTORY AND A PHYSICAL
ASSESSMENT FROM YOUR PAPER AND PRESENT IT AS A
PPT IN CLASS.
STUDENT ATTENDANCE
Students are to communicate directly with the course instructor regarding any circumstance that
may result in absence of course participation. Course participation is met through discussions in
class and/or postings and submission of assignments by the required due date. Due to the nature
of some discussions, instructors may not allow students to post in advance or in retrospect to
discussions due to absences. Students with an unexcused absence will receive a 50% grade
reduction for any assignment submitted during that week.
RNBSN ACADEMIC INFORMATION AND POLICIES
School of Graduate and Continuing Studies – Attendance Policy

One absence (and only one) may be excused without the grade being affected provided
make-up work is satisfactory completed:
o The learner must contact the instructor.
o The absence must be the result of unavoidable circumstances.
o Make-up work is satisfactory completed before the start of the following
workshop.
If the first absence is unexcused, the following scale will be used for grade reduction:
o For courses with 7, 8, or 9 workshops/sessions:
 1st absence will result in a final course grade no higher than a “B”
 2nd absence will result in a final course grade no higher than a “C”
 3rd absence will result in a final course grade of “F”
o For courses with 4, 5, or 6 workshops/sessions:
 1st absence will result in a final course grade no higher than a “C”
 2nd absence will result in a final course grade of “F”)
5
NRSG 355 9.2009






All subsequent absences (if first absence is excused) will result in an automatic grade
reduction.
The number of absences relative to grade reduction will reflect number of workshops in
the course (assuming one absence is excused based on the approved criteria listed above):
o For courses with 7, 8, or 9 workshops/sessions:
 2nd absence will result in a final course grade no higher than a “B”
 3rd absence will result in a final course grade no higher than a “C”
 4th absence will result in a final course grade of “F”
o For courses with 4, 5, or 6 workshops/sessions:
 2nd absence will result in a final course grade no higher than a “C”
 3rd absence will result in a final course grade of “F”
o For courses with 2 or 3 workshops/sessions
 An alternative cohort must be found so learner can attend the course in
total
Grades will be monitored with final attendance.
Grades must reflect absence – no exceptions.
If the first absence is not excused or the learner does not complete the necessary make-up
work, the grade will be reduced beginning with the first absence.
Instructors will address tardiness on an individual basis. Learners are expected to arrive
for class on time and remain for the entire four hour period.
Attendance – Online Courses
Students are required to participate in class three different days each week. Your initial
posting is NOT a RESPONSE to classmates. Both the quantity and quality of participation are
evaluated. In courses where there are team/group activities, those discussions are NOT counted
as part of the discussion postings. In addition to participation, the discussion rubric provides
further details on possible points according to quality of posting.
(Refer to the RNBSN Student Handbook for Policy Details)
Students are expected to communicate directly with the course instructor regarding any
circumstance that may result in absence of course participation. Course participation is met
through discussion postings and submission of assignments by the required due date.
1. Learners in online courses must post at least one substantive online message per course
week to be considered in attendance.
2. Failure to log in and post at least once a week will result in an unexcused absence. Grade
reductions according to the Attendance Policy in this handbook will be applied.
3. Participation is not the same as attendance. Participation requirements are determined by
6
NRSG 355 9.2009
the instructor and will be thoroughly explained in the course syllabus.
4. Students with an unexcused absence will receive a 50% grade reduction for any
assignments submitted during that week.
Instructors will address tardiness on an individual basis. Learners are expected to arrive for class
on time and remain for the entire session.
(Refer to the RNBSN Student Handbook for details)
EVALUATION PROCEDURE AND Grading System
95 – 100
A
92 – 94.9
A89 – 91.9
B+
86 – 88.9
B
83 – 85.9
B80 – 82.9
C+
77 – 79.9
C_____________________________________
74 – 76.9
CNon-passing scores
71 – 73.9
D+
68 – 70.9
D
65 – 67.9
DThe student will receive credit for assignments in the following ways:
DISCUSSIONS
The grading for discussion activities is outlined in the course-grading rubric. Students are
required to support their discussions with citations, write in APA and provide a reference list at
the bottom of their posting.
Participation points, which may be given, based on the Discussion Postings. If this is a required
part of the course assessment, the standard policy for discussion requirements and the grading
rubric are consistent in each course syllabus. When discussion is part of the required assessment
to ensure all members of the learning community have sufficient time to respond you are
expected to adhere to the following guidelines:




Post your initial activity no later than the third day of each week by midnight.
Respond to three of your colleagues’ initial postings during each week on three different
days.
Provide colleagues with reflective thoughts, personal experience, resources, or general
thoughts on the topic.
Posting after the required date will result in a grade reduction as stated in the rubric.
ASSIGNMENTS
Points will be given based on the assessment outlined for each course. Refer to the course
assignments and the corresponding grading rubric provided found in the course link identified as
7
NRSG 355 9.2009
(rubric). Each week the course guide will provide the student with the required assignment. The
learner as a guide for formulating written objectives should utilize the grading rubric for the
assignment.
Students with an unexcused absence will receive a 50% grade reduction for any assignment
submitted during that week.
LATE WORK POLICY
No late papers/assignments will be accepted after the date and time stated in the syllabus or
otherwise stated by the professor. In extreme circumstances exceptions may be made (i.e.
illness). However, this must be agreed upon by the student and professor prior to the due date.
POLICIES ON PLAGIARISM
Plagiarism is defined as use of intellectual material produced by another person without
acknowledging its course. For example:





Wholesale copying of passages from works of others into an assignment, paper, posting,
or thesis without acknowledgement.
Using the views, opinions, or insights of another without acknowledgement.
Paraphrasing another person’s characteristic or original phraseology, metaphor, or other
literary device without acknowledgment.
Faculty will monitor for evidence of plagiarism. All work must be submitted through the
correct blackboard process to be assessed for evidence of plagiarism.
Self-plagiarism is the use of the learner’s work from a previous class and is highly
discouraged. Should the learner’s previous work be used, it must be cited as such.
For further information on Olivet Nazarene University Conduct and Responsibilities, see the
Catalog at the course link (ONU Bulletin).
Students suspected of plagiarism require faculty to contact the Chair, Director of Nursing
Department at ONU directly.
OVERVIEW WEEK 1
In Siedel, Chapter 1 explores the importance of developing a partnership with the patient in order
to complete a thorough health history. Techniques are reviewed to assist the learner in
communicating with the patient effectively. Finally this chapter compares the history and
interviewing process for adults with the interviewing process for adults with the interviewing
process for special populations such as pregnant women, adolescents, children, and older adults.
Chapter 3 examines the techniques of inspection, palpation, percussion, and auscultation that are
used throughout the physical examination and the correct application for each technique.
Chapter 4 assists the learner to develop techniques to assess mental status. A review of the
history of present illness is presented with a discussion of abnormalities related to common
8
NRSG 355 9.2009
diagnoses. Finally, this chapter evaluates the mental status examination findings in relation to
common abnormalities of the adult and various populations.
Chapter 8 examines the anatomy and physiology of the skin, hair, and nails, including specifics
for special populations such as older adults, infants, and children. A review of the key elements
of the history of present illness, past medical history, and personal and social history is discussed
with special emphasis on each area of skin, hair and nails.
RESOURCES WEEK 1
Devotion
READING ASSIGNMENT WEEK 1
Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th
ed.). St. Louis: Mosby, Inc.
Chapter 1
Chapter 3
Chapter 4
Chapter 8
- “The History and Interviewing Process”
- “Examination Techniques”
- “Mental Status”
- “Skin, Hair, and Nails”
WEBSITES WEEK 1
Interactive online 'life change events' stress test From Stress Management™.
Roy Adaptation Model Web page of Sr. Callista Roy, PhD, RN, FAAN, Boston College.
Stress and Disease: The contribution of Hans Selye to Neuroimmune Biology. A personal
Reminiscence. An online article by Istvan Berczi, Department of Immunology, Faculty of Medicine,
University of Manitoba, Winnipeg, Manitoba, Canada.
AGENCIES AND ORGANIZATIONS
Association for Applied and Therapeutic Humor
National Institute of Mental Health
The Immune System: Friend and Foe "Four lectures on immunology by John W. Kappler, PhD, and
Philippa Marrack, PhD." Online video lectures from 1996, from the Howard Hughes Medical Institute.
Series requires RealOne Player to view. Includes: How Immune Cells Create Trillions of Receptors
from a Few Hundred Parts; How the Immune System Detects Invaders; How the Host Avoids "Friendly
Fire"; and Stalking the Elusive Pathogen.
9
NRSG 355 9.2009
Understanding the Immune System: How It works A 65 page online publication from the National
Cancer Institute and the National Institute of Allergy and Infectious Diseases, 2003.
CHAPTER 1 THE HISTORY AND INTERVIEWING PROCESS
AAFP Clinical Recommendations from the American Academy of Family Physicians.
Communicating with Patients and the online brochure The Patient Care Partnership:
Understanding Expectations, Rights and Responsibilities From the American Hospital
Association. Available in multiple languages.
"Talk to Me": Communication with Older Adults An online continuing education module from
the University of Florida Geriatric Education Center.
American Academy of Family Physicians
National Center on Elder Abuse - NCEA Includes an overview document The Basics: Major
Types of Elder Abuse.
CHAPTER 3 EXAMINATION TECHNIQUES
AAFP Clinical Recommendations From the American Academy of Family Physicians.
The Auscultation Assistant From UCLA; requires speakers for audio. Text and sound copyright
1997, Christopher Cable, MD.
Merck Manual of Geriatrics Editors Mark H. Beers, MD, and Robert Berkow, MD; Copyright©
by Merck & Co., Inc. Available online.
American Academy of Family Physicians An extensive site with material for patients and health
providers.
American Association of Nurse Assessment Coordinators For resident assessment in long term
care.
CHAPTER 4 MENTAL STATUS
A narrative approach to mental health in general practice Education and debate on "Narrative
based medicine"; "the second in a series of five articles on narrative based medicine"; by John
Launer, senior lecturer in general practice and primary care. BMJ - British Medical Journal
1999; 318:117-119 (9 January), full-text online.
CHAPTER 8 SKIN, HAIR, AND NAILS
Caring for Wounds and Pressure Ulcers Online continuing education program from the
University of Florida; part of a larger program Health Management for Older Adults. Includes
10
NRSG 355 9.2009
audio presentations.
Diabetic Foot Ulcers: Prevention, Diagnosis and Classification An online article by David G.
Armstrong, DPM, and Lawrence A. Lavery, DPM, MPH; American Family Physician, March
15, 1998.
Integumentary Assessment By Peg Gray; a slide presentation that focuses on the nails.
Dermatology Nurses Association
OTHER RESOURCES WEEK 1
Click here for Power Points to support learning this week!
The History and Interviewing Process
Examination Techniques and Equipment
Mental Status
Skin, Hair, and Nails
DISCUSSION ACTIVITY WEEK 1
1. Investigate the website on Roy’s Adaptation System Theory. Compare and contrast her
theory and how it relates to your health and how you handle stress.
2. Take the online “life change events” stress test. Review the results from the test. Do these
“events” have a positive or a negative effect on your life and how can you learn from
these changes?
3. Describe how immunology affects your particular patient population.
4. Post your discussion to the board.
5. Read all of your colleagues’ postings.
6. Respond to at least three of your colleagues’ initial postings.
*Be sure to support your posting with citations from this week’s resources. Refer to the APA
Publication Manual to assure your citations in the text and reference list are correct.
ASSIGNMENT WEEK 1
There is no assignment for Week One.
Looking Ahead Tip:
Looking ahead to Week Two your activity will be posting on the discussion board a case
scenario that you must complete. You must critique one of your colleagues’ work on their case
studies and post the critique so they may have feedback in a timely manner. You will be graded
11
NRSG 355 9.2009
on your response. To enhance your learning, you are encouraged to select a case study on a
patient population that will challenge you. For example if your practice entails Geriatrics, pick a
Pediatric case to expand your knowledge base.
Case Study is due in Week 2 - Day 3 by 11:59 p.m.
OVERVIEW WEEK 2
This week you will review topics include Alterations in oxygen transport and gas exchange,
obstructive and restrictive pulmonary disorders. The learner will discuss the causes and effect of
hypoxia, and the pathophysiological causes of anemia.
In Siedel, you will be reading Chapter 2, which examines culture and its impact on health
assessment and care of the patient. Definitions of cultural competence and cultural awareness are
reviewed. In addition, this chapter compares and contrasts the patient-centered model with the
family-centered model of health care. Finally this chapter examines the impact of cultural
response and the components that affect the clinician’s health assessment.
Chapter 13 discusses the anatomy and physiology of the respiratory system. Age-specific
variations in the chest and lung examinations are distinguished from the adult population. In
addition, an analysis of normal and abnormal examination findings are related to various
conditions of the chest and lungs. Finally this chapter evaluates the history and physical
examination findings for common abnormalities.
RESOURCES WEEK 2
Devotion
READING ASSIGNMENT WEEK 2
Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th
Ed.). St. Louis: Mosby, Inc.
Chapter 2 - “Culture Awareness”
Chapter 13 - “Chest and Lungs”
WEBSITES WEEK 2
Blood-Chemistry Tutorials Online tutorials from the Chemistry Department, Washington
University, St. Louis; includes Hemoglobin and the Heme Group: Metal Complexes in the Blood
for Oxygen Transport; Iron Use and Storage in the Body: Ferritin and Molecular
Representations; Maintaining the Body's Chemistry: Dialysis in the Kidneys; and Blood, Sweat,
and Buffers: pH Regulation during Exercise.
12
NRSG 355 9.2009
Sickle Cell Anemia From the National Heart, Lung and, Blood Institute; requires Adobe
Acrobat.
RESPIRATORY FUNCTION AND ALTERATIONS IN GAS EXCHANGE
Acid-Base Tutorial By Alan W. Grogono, MB, BS, MD, FRCA, Tulane University School of
Medicine.
The Auscultation Assistant By Christopher Cable, MD, UCLA School of Medicine. This site
requires considerable disk cache space.
The Human Respiratory System Extensive site from the American Lung Association that
includes an animated explanation of how the lungs work.
Interactive Respiratory Physiology By Wilmot C. Ball Jr., MD, Johns Hopkins School of
Medicine. Includes Tutorials, an encyclopedia, dictionary, and interactive quizzes that provide
immediate feedback.
OBSTRUCTIVE PULMONARY DISORDERS
Asthma An extensive interactive tutorial from the University of California at San Diego School
of Medicine.
Chronic Bronchitis: Primary Care Management Online article by John M. Heath, MD, from
American Family Physician, May 15, 1998.
Chronic Obstructive Pulmonary Disease: Epidemiology and Evaluation Online article by David
M. Mannino, MD, FCCP, from Hospital Physician, October 2001.
LungCancer.org Copyright © 2007 by It's Time To Focus On Lung Cancer; sponsored by Cancer
Care, Inc. and the Oncology Nursing Society; contains both professional and patient resources.
RESTRICTIVE PULMONARY DISORDERS
The Acute Respiratory Distress Syndrome: Myths and Controversies By Joseph Varon, MD,
FACA, FACP, and Olivier Wenker, MD, DEAA; online article from the Internet Journal of
Emergency & Intensive Care Medicine.
Acute respiratory distress syndrome Online article by Kahdi F. Udobi, MD, Ed Childs, MD, and
Karim Touijer, MD, from American Family Physician, January 15, 2003.
Respiratory Distress Syndrome From the Neonatal Handbook, Newborn Emergency Transport
Service, Victoria, Australia.
Severe Acute Respiratory Syndrome (SARS) Guidelines and recommendations from the Centers
for Disease Control and Prevention.
13
NRSG 355 9.2009
CULTURAL AWARENESS
Checklists for cultural assessment From the State of Queensland, Queensland Department of
Health, Australia site on Multicultural Health.
Clinical Practice Guidelines for Nurses in Primary Care An online guide from Health Canada;
covers multiple organ systems; "intended primarily for use by qualified and licensed nurses
working in nursing stations and treatment health centers located in semi-isolated and isolated
First Nations and Inuit communities". There is also a site for Pediatric Clinical Practice
Guidelines for Nurses in Primary Care.
Transcultural Nursing: Basic Concepts & Case Studies; Created by Victor Fernandez RN and
Kathy Fernandez RN. Sites include: Asian Community; Hispanic American Community; Middle
Eastern Community; Deaf Culture; The Black-American Community; A Hispanic Migrant
Community Assessment.
OTHER RESOURCES WEEK 2
Click here for Power Points to support learning this week!
Cultural Awareness
Chest and Lungs
DISCUSSION ACTIVITY WEEK 2
1. Choose one case study from those listed below.
2. After reading the case study, what were the pertinent laboratory findings, the etiology of
the disease process, and what would you expect to find on your physical assessment of
the patient?
3. What compensatory mechanisms are occurring in the patient?
4. Post your discussion to the board.
5. Read all of your colleagues’ postings.
6. Respond to at least three of your colleagues’ initial postings.
*Be sure to support your posting with citations from this week’s resources. Refer to the APA
Publication Manual to assure your citations in the text and reference list are correct.
CASE STUDIES
1. Pediatric Case Study: C.Q. was recently exposed to a group a hemolytic streptococcus
and subsequently developed pharyngeal infection. Clinical examination by the nurse
reveals an oral temperature of 102.3, skin rash, and reddened throat mucosa with multiple
pustules. C.Q. complains of sore throat, malaise, and joint stiffness.
14
NRSG 355 9.2009
2. Older Adult Case Study: R.V. is a 72-year-old male in the clinic for increasing
shortness of breath. On physical examination, he is found to be slightly hypertensive at
150/94 and has a ruddy complexion. He is a long –time cigarette smoker. Laboratory
evaluation reveals a hematocrit of 50% with hemoglobin of 20g/dL. Oximetry reveals a
hemoglobin saturation of 92%.
3. Middle Age Case Study: R.S. worked for many years spray-painting cars at his
autobody repair business. He has bronchitis COPD. He also has a history of coronary
artery disease and peripheral vascular disease. His arterial blood has values are: pH=7.23,
PaCO2=60 mm Hg, PaO2=50mm Hg, HCO3= 30mEq/L. His hematocrit is 52% with
normal red cell indices. He is taking an inhaled beta agonist and the theophylline to treat
his respiratory condition. At his clinic visit, the nurse notes that R.S. has an area of
consolidation in his right lobe thought to be consistent with pneumonia.
ASSIGNMENT WEEK 2
There is no assignment for Week Two.
LOOKING AHEAD TIP!
In WEEK 4 - DAY 3 you will have a 3-5 page typed written paper due on the pathophysiology
of a disease process and the assessment findings you may find in that particular disease process.
This does not include the title or reference page. You should focus on a disease process that
you have learned about or unfamiliar with. Some diseases you may want to focus on are:
Autoimmune Diseases (i.e., Rheumatoid Arthritis, Lupus, Diabetes Mellitus, etc.),
Cardio/Pulmonary or any Neoplasm Disease Process. In addition to writing about the
pathophysiology, you will include the assessment findings in that particular patient. You are
encouraged to focus on a patient population that you are unfamiliar with to expand your
knowledge base. You will frame your discussion around the physical, emotional, and spiritual
needs of the patient. Please make sure you get your topic cleared by your instructor by WEEK 3.
MAJOR POINTS TO FOCUS IN THE PAPER:
1.
2.
3.
4.
Identify the population you will discuss
Explain the Pathophysiology
Describe the assessment findings of your selected disease
Discuss the physical, emotional and spiritual needs of the patient with your selected
disease.
Specific APA requirements include:
1.
You want to make sure the content of the paper is comprehensive, and accurate.
A.
B.
C.
Major points are stated clearly, and are supported by specific details, examples
and analysis.
Research is adequate and timely for the topic
The content and purpose of the writing is clear.
15
NRSG 355 9.2009
2.
Organization
A.
B.
C.
D.
3.
Format
A.
B.
4.
The paper follows designated guidelines for APA format including
citations references.
The paper uses reference appropriately
Grammar/Punctuation/Spelling
A.
B.
C.
5.
The introduction provides sufficient background on the disease and previews
major points.
The structure of the paper is clear and easy to follow.
The paper’s organization emphasizes the central theme or purpose and is directed.
Paragraph transitions are present and logical and maintain the flow of thought
throughout the paper.
Spelling is correct.
Word usage is correct.
Punctuation is correct.
Readability/Style
A.
B.
C.
D.
E.
Sentences are complete, clear, and concise.
Sentences are well constructed with consistently strong, varied,
structure
Sentence transitions are presented and maintain the flow of
thought.
The tone is appropriate to the content and assignment.
Development of each paragraph provides one idea per paragraph and provides
consistency and flow
PLEASE REFER TO THE GRADING RUBRIC FOR THE BREAK DOWN OF POINTS
IN EACH SECTION.
OVERVIEW WEEK 3
This week your review addresses cardiac function. Chapter 14 in Siedel describes the anatomy
and physiology of the heart. Age-related and diagnosis variations of the heart are discussed.
Interviewing techniques related to the heart and condition variations are described. Finally, this
chapter examines the health history and physical examination related to symptoms and clinical
findings associated with cardiac abnormalities.
Chapter 15 in Siedel begins with the anatomy and physiology of blood vessels. Age-related and
condition variations are described. A discussion of interviewing techniques to gather data for the
16
NRSG 355 9.2009
health history related to the blood vessels is described. Finally abnormal history and physical
examination findings are discussed related to various pathologic conditions of the blood vessels.
RESOURCES WEEK 3
Devotion
READING ASSIGNMENT WEEK 3
Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th
ed.). St. Louis: Mosby, Inc.
Chapter 14 - “Heart”
Chapter 15 - “Blood Vessels”
WEBSITES WEEK 3
CARDIAC FUNCTION
Aspirin as a Therapeutic Agent in Cardiovascular Disease A Statement for Healthcare
Professionals From the American Heart Association.
The Auscultation Assistant By Christopher Cable, MD, UCLA School of Medicine; this site
requires considerable disk cache space.
ALTERATIONS IN CARDIAC FUNCTION
ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure
in the Adult—Summary Article From the Journal of the American College of Cardiology, 2005;
46:1116-1143.
National Heart Lung and Blood Institute (NHLBI) and NHLBI Morbidity and Mortality Chart
Book 2004 which requires Adobe Acrobat.
National High Blood Pressure Education Program (NHBPEP) Contains online slide sets and
other resources; from the National Heart, Lung, and Blood Institute (NHLBI).
AGENCIES AND ORGANIZATIONS
American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)
American Association of Critical-Care Nurses (AACN)
HEART FAILURE AND DYSRHYTHMIAS: COMMON SEQUELAE OF CARDIAC
DISEASES
17
NRSG 355 9.2009
Antiarrhythmic Agents From Einthoven Advances in Cardiac Arrhythmias site.
EKG Quiz Extensive ECG site from McGill University. .
Heart Failure Society of America Maintains an extensive consumer level site About Heart
Failure, which includes an online learning module on Heart Failure Medicines.
Managing Heart Failure: A Case Study Approach Online continuing education article by Mary
MacKlin, from the American Association of Critical-Care Nurses.
SHOCK
Cardiogenic Shock From eMedicine World Medical Library.
Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries By
the Committee on Fluid Resuscitation for Combat Casualties, Institute of Medicine; 208 pages,
1999. Full text online from the National Academies Press.
Practice Parameters for Hemodynamic Support of Sepsis in Adult Patients Guideline from the
Society of Critical Care Medicine.
http://evolve.elsevier.com/Seidel
HEART
Aspirin as a Therapeutic Agent in Cardiovascular Disease A Statement for Healthcare
Professionals From the American Heart Association.
The Heart An Online Exploration from the Franklin Institute, consumer level.
Heart Sounds and Murmurs Includes audio and video files; from Introduction: Examination for
Heart Sounds and Murmurs, Advanced Physical Diagnosis Skills for the Bedside By Linda E.
Pinsk, MD, and Linda E. Pinsky, MD, Department of Medicine, University of Washington,
Seattle.
AGENCIES AND ORGANIZATIONS
American Association of Critical-Care Nurses Includes many online continuing education
articles related to cardiovascular disorders.
American College of Cardiology An extensive site with many useful items, including expert
consensus documents.
American College of Chest Physicians
Council on Cardiovascular Nursing of the American Heart Association
Kids with Heart National Association for Children's Heart Disorders, Inc.
18
NRSG 355 9.2009
National Heart, Lung, and Blood Institute - NHLBI
Society for Vascular Nursing
OTHER RESOURCES WEEK 3
Click here for Power Points to support learning this week!
1. Heart
2. Blood Vessels
DISCUSSION ACTIVITY WEEK 3
1. Choose one case study from those listed below.
2. After reading the case study, what were the pertinent laboratory findings, the etiology of
the disease process, and what would you expect to find on your physical assessment of
the patient?
3. What compensatory mechanisms are occurring in the patient?
4. Post your discussion to the board.
5. Read all of your colleagues’ postings.
6. Respond to at least three of your colleagues’ initial postings.
*Be sure to support your posting with citations from this week’s resources. Refer to the APA
Publication Manual to assure your citations in the text and reference list are correct.
CASE STUDIES
1. Older Adult Case Study: A.O. was an 89-year-old woman with a long history of
congestive heart failure secondary to a large left ventricular infarct. She has poor activity
tolerance and required assistance with activities of daily living. Even minimal activity
was associated with moderately severe dyspnea and exertional chest pain, which was
relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She took digitalis,
Lasix, KCl, and sublingual nitroglycerin.
2. Pediatric Case Study: C.J. is a 12-yar-old high school student who is in the clinic for
sports physical prior to beginning basketball practice. The nurse assesses that he has no
known allergies. A review of systems reveals only that C.J. gets winded earlier than most
boys on the team. He attributes this to needing to get in better shape. The physical exam
is unremarkable except for a grade III systolic murmur heard over the entire pericardium.
An echocardiogram and cardiac cath reveals a VSD with moderate pulmonary
hypertension.
19
NRSG 355 9.2009
3. Young Adult Case Study: T.V. is hospitalized with deep vein thrombosis in her left leg
as a complication of abdominal surgery. She is being treated with bed rest and
anticoagulant therapy. On the third postoperative day, she suddenly experiences severe
dyspnea and is placed on supplemental oxygen. A blood gas is drawn with demonstrated
hypoxemia and mild respiratory alkalosis.
ASSIGNMENT WEEK 3
There is no assignment for Week Three.
OVERVIEW WEEK 4
The purpose of this week is to understand how the CNS, peripheral nervous system, and the
autonomic nervous system interrelate.
Different types of traumatic brain injury, increased intracranial pressure, and under what
conditions these occur are reviewed. The three different types of strokes are compared and
contrasted. Meningitis, encephalitis, infective organisms, CSF fluid findings, clinical
manifestations, and treatment are all presented.
Chapter 21 of Siedel covers the anatomy and physiology of the musculoskeletal system. The
musculoskeletal anatomy and physiology of various populations are reviewed. Interviewing
techniques are described to assist in information gathering of the musculoskeletal system. Health
history and physical examination findings that deviate from normal are evaluated to correlate
with clinical findings of common pathologic conditions of the musculoskeletal system.
Chapter 22 begins with a description of the anatomy and physiology of the neurologic system.
Variations of the neurologic system in selected populations are also described. The techniques of
the physical examination are examined with a discussion of specific abnormal findings. Finally,
common pathologic disorders are described with related symptoms and clinical findings.
RESOURCES WEEK 4
Devotion
READING ASSIGNMENT WEEK 4
Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th
ed.). St. Louis: Mosby, Inc.
Chapter 21 - “Musculoskeletal System”
Chapter 22 - “Neurologic System”
REMEMBER YOUR PAPER IS DUE THIS WEEK!!!
20
NRSG 355 9.2009
WEBSITES WEEK 4
Nervous System From JayDoc HistoWeb; University of Kansas Medical Center; illustrations and
text.
The Whole Brain Atlas By Keith A. Johnson, MD, J. Alex Becker, Harvard University.
ACUTE DISORDERS OF BRAIN FUNCTION
Management of the Acute Migraine Headache Online article by Glen Aukerman, MD, Doug
Knutson, MD, and William F. Miser, MD, MA, from American Family Physician, December 1,
2002.
Stroke From the American Heart Association. Comprehensive information regarding stroke and
the role that the AHA plays in fighting this disease. Check out the links at the bottom of the
page. There is also a collection of Scientific Publications on Stroke, and American Heart
Association Heart and Stroke Statistical Update.
Stroke Statistical overview from the CDC.
AGENCIES AND ORGANIZATIONS
American Stroke Association A division of the American Heart Association.
Brain Injury Association
National Headache Foundation
National Institute of Neurological Disorders and Stroke
National Stroke Association
CHRONIC DISORDERS OF NEUROLOGIC FUNCTION
Multiple Sclerosis An online tutorial from Knowledge Weavers, Spencer S. Eccles Health
Sciences Library; University of Utah; © John W. Rose, MD; Maria Houtchens, MSIII; and
Sharon G. Lynch, MD.
Neuromuscular Disease Center At Washington University School of Medicine, St. Louis;
comprehensive site, large sections on specific diseases, diagnostic procedures, anatomy,
physiology, toxic neuropathies, and much more.
AGENCIES AND ORGANIZATIONS
American Academy of Neurology
American Association of Spinal Cord Injury Nurses
National Spinal Cord Injury Association
21
NRSG 355 9.2009
ALTERATIONS IN SPECIAL SENSORY FUNCTION
Age-Related Macular Degeneration: What you should know Information from the National Eye
Institute.
Cataract: What you should know Information from the National Eye Institute.
Eye and Ear From JayDoc: HistoWeb; lavish illustrations; University of Kansas Medical Center.
PAIN
Efficacy of Cold for Pain: Fact or Fallacy? An Online Continuing Education Program article by
Jenny Sauls, RNC, DSN, from Sigma Theta Tau International.
The Use of Opioids for the Treatment of Chronic Pain "A consensus statement from the
American Academy of Pain Medicine and the American Pain Society."
http://evolve.elsevier.com/Seidel
MUSCULOSKELETAL SYSTEM
Bone Cancer "oncologist-approved cancer information" from People Living With Cancer, "the
patient information website of the American Society of Clinical Oncology (ASCO)."
Musculoskeletal System Chapter 7 of the Clinical Practice Guidelines for Nurses in Primary
Care, an online guide from Health Canada; "intended primarily for use by qualified and licensed
nurses working in nursing stations and treatment health centers located in semi-isolated and
isolated First Nations and Inuit communities". Includes sections on common problems and
emergencies.
Osteoarthritis An online audiovisual tutorial from the National Library of Medicine.
Osteoporosis An online audiovisual tutorial from the National Library of Medicine.
NEUROLOGIC SYSTEM
Advances in the Treatment of Epilepsy Online article by Selim R. Benbadis, MD, and William
O. Tatum IV, DO; from American Family Physician, July 1, 2001; includes a link to a patient
handout.
American Academy of Neurology Practice Guidelines These cover a wide range of topics.
Head and Brain Injuries A collection of links to web resources from Medline Plus.
History & Physical Examination: Clinical Patterns Part of the web site Neuromuscular
Evaluation Protocols on the Neuromuscular Disease Center site, Washington University School
of Medicine, St. Louis. Also includes information on Lab Testing: Especially for treatable
diagnoses after history & examination and Nerve Biopsy.
22
NRSG 355 9.2009
Stroke From the American Heart Association. Comprehensive information regarding stroke and
the role that the AHA plays in fighting this disease. Check out the links at the bottom of the
page. There is also a collection of Scientific Publications on Stroke.
OTHER RESOURCES WEEK 4
Click here for Power Points to support learning this week!
Musculoskeletal System
Neurologic System
DISCUSSION ACTIVITY WEEK 4
1. Choose one case study from those listed below.
2. After reading the case study, what were the pertinent laboratory findings, the etiology of
the disease process, and what would you expect to find on your physical assessment of
the patient?
3. What compensatory mechanisms are occurring in the patient?
4. Post your discussion to the board.
5. Read all of your colleagues’ postings.
6. Respond to at least three of your colleagues’ initial postings.
*Be sure to support your posting with citations from this week’s resources. Refer to the APA
Publication Manual to assure your citations in the text and reference list are correct.
CASE STUDIES
1. Older Adult Case Study: J.S. is a 72-year-old woman with a long history of
atherosclerosis. One afternoon, her grandson found her sitting in a chair staring blankly.
She was tilting toward the right, drooling, and had been incontinent of urine. She was
able to focus her eyes on him, when he spoke to her, but she was unable to verbalize a
response. She was transported to the local hospital and diagnosed with CVA.
2. Young Adult Case Study: T.L. is a 32-year-old mother of two, has a history of multiple
sclerosis for 5 years. She is currently enrolled in a school of nursing. Her husband is
supportive and helps with the care of their preschool sons. T.L. is visiting the clinic today
for diagnostic studies related to symptoms of visual disturbances.
3. Pediatric Case Study: M.N. is a 13year-old male who received a head injury as a result
of a bike accident. You noticed he has increased ICP of 30mmHg as a result of a massive
closed head injury.
ASSIGNMENT WEEK 4
23
NRSG 355 9.2009
Your Pathophysiology and Assessment Paper Part I is due on Day 4 of this week.
LOOKING AHEAD TIP!
In WEEK 6 - Day 3, as a final project in the class, you will be doing a Power Point Presentation
on your paper. You will be presenting on your disease process and your assessment findings.
This presentation should include how you would be teaching a new graduate nurse on how to
assess your patient with this particular disease process. Please have the presentation approved by
your instructor 1 WEEK prior to presenting for approval by your instructor. The Power Points
need to be professional looking. The presentation itself should be about 5 minutes in length. The
information on the slides should include the following information:
1.
2.
3.
4.
5.
Introduction of your presentation
Description of the disease and the pathophysiology
Assessment findings
Physical, Emotional and Spiritual needs of your patient
Teaching Perils for the New Graduate Nurse
You should expect 1 minute per slide. You should have a total of 8 slides. Your slides should
include: a title page and a reference slide at the end.
Please refer to the grading rubric for Power Point Presentation for Week 6 for a
breakdown of Points.
OVERVIEW WEEK 5
For this week, the learning includes the difference between neoplastic from normal cells, how
benign and malignant cells differ. You will explain the relationship between immunosuppression
and cancer. The chapter concludes with how personal history, social history, and nutrition relate
to preventions, remission, and healing of cancer.
Chapter 24 in Siedel examines the physical examination sequence, discussing patient positioning
and its relation to the specific examinations completes. Techniques for examining infants,
children, pregnant women, older adults, and adult patients are compared. Finally, this chapter
summarizes a functional assessment for the older adult.
RESOURCES WEEK 5
Devotion
READING ASSIGNMENT WEEK 5
24
NRSG 355 9.2009
Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th
ed.). St. Louis: Mosby, Inc.
Chapter 24 - “Putting it all together”
WEBSITES WEEK 5
Cancer Guide A site for cancer patients on how to research their own disease.
Cancer Literature An extensive resource from the National Cancer Institute that includes openaccess to PDQ (state of the art summaries on cancer therapies for physicians and patients) and an
online bibliographic database for researching cancer topics that is searchable via PubMed.
Preventing and Controlling Cancer: The Nation's Second Leading Cause of Death Information
from the National Center for Chronic Disease Prevention and Health Promotion, Centers for
Disease Control and Prevention.
DATABASES
The National Cancer Institute has many full text documents, and online Cancer Literature
resources. This site includes a dictionary, information on treatment options for specific types of
cancer, resources and literature, and the access to a searchable database of articles via PubMED.
Some materials are available in English and Spanish.
RESOURCES WEEK 5
Click here for Power Points to support learning this week!
Putting It All Together
DISCUSSION ACTIVITY WEEK 5
1. Choose one case study from those listed below.
2. After reading the case study, what were the pertinent laboratory findings, the etiology of
the disease process, and what would you expect to find on your physical assessment of
the patient?
3. What compensatory mechanisms are occurring in the patient?
4. Post your discussion to the board.
5. Read all of your colleagues’ postings.
6. Respond to at least three of your colleagues’ initial postings.
*Be sure to support your posting with citations from this week’s resources. Refer to the APA
Publication Manual to assure your citations in the text and reference list are correct.
25
NRSG 355 9.2009
CASE STUDIES
1. Karen is a 38 year old white female in good health presenting with a chief complaint of a
small lump in the left breast of approximately 18 months duration. A mammogram was
performed in May and again in August with both normal. Ultrasound was also performed
in October. Karen was informed by her physician that the lump was fibrocystic and
benign. Father died age 62 from MI, mother and three sisters are healthy. Divorced with 2
daughters ages 10 and 11. She is employed as an occupational therapist. Menses at age
16.
2. Mr.Titus had problems with repeated falls. In June 1982, he went to his doctor who,
among other tests, carried out a needle biopsy on his brain. This produced a diagnosis of
astrocytoma (brain cancer), very bad news indeed, which was given to the patient on his
birthday, June 25th . Mr. Titus consulted two other doctors for their "second opinions,"
but the diagnosis and the prognosis were the same: he would be dead by Christmas.
Surgery was offered as a treatment option. However, he had a friend who some six
months earlier had submitted to surgery for a brain tumor. He had emerged from the
surgery reduced to the status of a vegetable, and had died shortly before Edward was
given his diagnosis. With this experience fresh in his mind, he refused surgery.
3. A 31-year-old man was admitted to your oncology unit with an enlarged testicular mass
that had been present for 1 y, left leg pain, weakness, and numbness of 6 months'
duration. For the past 2 mo he needed crutches, 30-pound weight loss over the year.
Abnormalities on physical examination were tenderness over the left iliac crest and an 8
cm non-tender mass in the right testis. No muscle wasting was noted, but left hip flexion
and quadriceps strength were diminished. Left patellar tendon and ankle reflexes were
absent, and sensation was decreased over the medial aspect of the left thigh.Laboratory
examination showed WBC 11.6 k/µl, Hct 43%, Hb 13.8 g/dl, platelets 520 k/µl. LDH
was 612 units, alpha-fetoprotein 13,000 units, and ß-hCG 69 units.Radiographic findings
included multiple 0.5 to 2 cm lung nodules. CT scans of the abdomen showed a mass
eroding the left side of the pelvis and involving gluteal muscles but not viscera, and a
pathologic fracture of the left femoral head. Small retroperitoneal nodes were also noted.
A right radical orchiectomy was performed.
ASSIGNMENT WEEK 5
There is no assignment for Week Five.
LOOK AHEAD TIP:
Reminder your PPT is DUE NEXT WEEK!
OVERVIEW WEEK 6
26
NRSG 355 9.2009
This last week you will present your PPT to the class. Post your PPT on Blackboard, make sure
to have them posted/available no later than Week 6 – Day 3 so your colleagues may respond to
them. Remember to refer to the rubric for grading of the PPT. Allow for time after the
presentations for any questions.
RESOURCES WEEK 6
Devotion
READING ASSIGNMENT WEEK 6
There is no reading assignment for Week 6.
DISCUSSION ACTIVITY WEEK 6
1. How would you describe your personal and professional growth today?
2. Give one example of how you have expanded your knowledge in health assessment.
3. Using a disease process you have discussed in during this course, provide a journal article
as an example of how to address primary, secondary, and tertiary prevention in your
practice.
4. Post your discussion to the board.
5. Read all of your colleagues’ postings
6. Respond to at least three of your colleagues’ initial postings.
ASSIGNMENT WEEK 6
Your PowerPoint Posting is due on Day 3 this week.
In WEEK 6 - Day 3, as a final project in the class, you will be doing a Power Point Presentation
on your paper. You will be presenting on your disease process and your assessment findings.
This presentation should include how you would be teaching a new graduate nurse on how to
assess your patient with this particular disease process. Please have the presentation approved by
your instructor 1 WEEK prior to presenting for approval by your instructor. The Power Points
need to be professional looking. The presentation itself should be about 5 minutes in length. The
information on the slides should include the following information:
1.
2.
3.
4.
5.
Introduction of your presentation
Description of the disease and the pathophysiology
Assessment findings
Physical, Emotional and Spiritual needs of your patient
Teaching Perils for the New Graduate Nurse
27
NRSG 355 9.2009
You should expect 1 minute per slide. You should have a total of 8 slides. Your slides should
include: a title page and a reference slide at the end.
Please refer to the grading rubric for Power Point Presentation for Week 6 for a
breakdown of Points.
FINAL COURSE REMINDERS!

CHECK THE PORTFOLIO GUIDELINE FOR ARTIFACTS REQUIRED FOR
THIS COURSE.

REMEMBER TO COMPLETE THE ONLINE COURSE ASSESSMENT.
28
NRSG 355 9.2009
References
American Psychological Association. (2001). Publication manual of the American Psychological
Association (5th ed.). Washington, DC: America Psychological Association.
Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th
ed.). St. Louis: Mosby, Inc.
29
NRSG 355 9.2009
GRADING RUBRICS
DUE WEEK# 4 - DAY 3: PATHOPHYSIOLOGY AND ASSESSMENT
PAPER
PART I
CONTENT
Clear
identification of
the population
that is discussed
POSSIBLE
POINTS
5.5
Discussion on the
Pathophysiology
of the disease
process
6
Description of the
assessment
findings of your
selected disease
10
Identifies the
physical,
emotional and
spiritual needs of
the patient
10
The paper follows
designated
guidelines for
APA format
including citations
and references
Total Points
3.5
35
POINTS
RECEIVED
FACULTY
COMMENTS
Received
Support your work with citations from Journal articles, textbook assigned
readings, and other scholarly references utilized throughout the course.
30
NRSG 355 9.2009
DUE WEEK# 6 – DAY 3: POWER POINT PRESENTATION
CONTENT
Introduction
POSSIBLE
POINTS
2.5
Discussion of the
pathophysiology
of the disease
5
Description of the
assessment
findings.
9
Spiritual,
emotional, and
physical needs
5
Teaching perils of
the new graduate
nurse
5
Professionalism
of the
presentation
5
References
3.5
Total Points
35
POINTS
RECEIVED
FACULTY
COMMENTS
Received
Support your work with citations from Journal articles, textbook assigned
readings, and other scholarly references utilized throughout the course.
31
NRSG 355 9.2009
Discussion Requirements and Rubric
Up to 0.5 points can be deducted for APA and/ or grammar.
5 Points (Exemplary)

Discussion postings and responses are responsive to the requirements of the Discussion
instructions and are posted by the due date.

Discussion postings and responses significantly contribute to the quality of interaction by
providing rich and relevant examples, applicable research support, discerning ideas,
and/or stimulating thoughts/probes, and are respectful when offering suggestions,
constructive feedback, or opposing viewpoints.

Discussion postings and responses demonstrate an in-depth understanding of concepts
and issues presented in the course (e. g., insightful interpretations or analyses, accurate
and perceptive parallels, and well-supported opinions), and are well supported, when
appropriate, by pertinent research.

Discussion postings and responses provide evidence that the student has read and
considered a sampling of colleagues' postings and synthesized key comments and ideas,
as applicable.
4 Points (Proficient)

Discussion postings and responses are responsive to the requirements of the Discussion
instructions and are posted by the due date.

Discussion postings and responses contribute to the quality of interaction by providing
examples, research support when appropriate, ideas, and/or thoughts/probes, and are
respectful when offering suggestions, constructive feedback, or opposing viewpoints.

Discussion postings and responses demonstrate some depth of understanding of the issues
and show that the student has absorbed the general principles and ideas presented in the
course, although viewpoints and interpretations are not always thoroughly supported.

Discussion postings and responses provide evidence that the student has considered at
least some colleagues' postings and synthesized some key comments and ideas, as
applicable.
3 Points (Sufficient)

Discussion postings and responses are posted by the due date but are not always
responsive to the requirements of the Discussion instructions.

Discussion postings and responses do little to contribute to the quality of interaction or to
stimulate thinking and learning.

Discussion postings and responses demonstrate a minimal understanding of concepts
presented, tend to address peripheral issues, and, while generally accurate, display some
omissions and/or errors.
32
NRSG 355 9.2009

Discussion postings and responses do not provide evidence that the student has
considered at least some colleagues' postings or synthesized at least some key comments
and ideas, as applicable.
2 or Less Points (Developing)

Discussion postings and responses are posted past the late deadline, defined as 11:59 p.m.
on the due date, and/or do not address the requirements of the Discussion instructions.

Discussion postings and responses do not contribute to the quality of interaction or
stimulate thinking and learning.

Discussion postings and responses do not demonstrate an understanding of the concepts
presented in the course, and/or do not address relevant issues, and/or are inaccurate and
contain many omissions and/or errors.

Discussion postings and responses do not provide evidence that the student has read or
considered colleagues’ postings, as applicable.
Possible Points = 30
33