TRINITAS SCHOOL OF NURSING
NURE 212
HEALTH AND PHYSICAL ASSESSMENT
COURSE DESCRIPTION:
NURE 212 builds upon the foundation of LPN education and introduces the student to holistic health
assessment and physical examination. The course aims to develop the student’s abilities in gathering
data to determine client’s health status, practices and goals as influenced by his/her own culture. Starting
with assessment of normal health parameters, the student will learn to differentiate between what is
within and out of acceptable limits. Within the context of care of the perioperative or gerontological client,
the student will learn and use physical assessment techniques of inspection, palpation, percussion and
auscultation as well as other forms of data collection, such as, client interview, chart review, and analysis
of laboratory and diagnostic results. The roles of the RN and the LPN in physical assessment/data
collection will be discussed. The student will practice physical assessment skills and participate in
laboratory experiences using scenarios involving a patient simulator in the Skills laboratory and in the
application of concepts in acute health care settings. Students will also review and perform basic clinical
nursing skills.
Theory Hours:
Clinical Hours:
Credits:
Duration:
2 hours/week
6 hours/week
4 credits
15 weeks
FACULTY:
Ariel Almacen, APN, PsyD, MSN, FNP, CCRN, CEN, RN, C
M. E. Kelley, MSN, MEd, RN, CNE
PRE-REQUISITES:
Proof of current LPN license
Satisfactory completion of NJ Basic Skills Test/Course or waiver
G.P.A. 2.3
BIO 105, BIO 106, BIO 108,CHE 105 or CHE 113/114
ENG 101, ENG 102, PSY 101, PSY 205, SOC 101, HUMANITIES ELECTIVES (6 credits)
One year employment as an LPN in a health care setting
CO-REQUISITES:
NURE 211
THE STUDENT IS RESPONSIBLE FOR ALL INFORMATION CONTAINED IN THE STUDENT HANDBOOK
Copyright 2006-2007. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without the prior permission of Trinitas School of Nursing.
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COURSE OBJECTIVES FOR NURE 212
Upon completion of this course, the student will:
1. Perform a comprehensive health and physical assessment of a client/individual.
2. Demonstrate the use of effective and culturally-sensitive communication techniques in history taking and interviews with clients.
3. Utilize the nursing process and critical thinking in determining client’s health status.
4. Integrate knowledge of anatomy and physiology in the physical assessment process and interpretation of findings.
5. Document assessment findings and health history accurately using available resources.
6. Demonstrate psychomotor ability in performing basic clinical nursing skills
7. Utilize available technological resources in the libraries, and the skills and computer laboratories.
All students enrolled in Trinitas School of Nursing NURE/NREL courses will be required to adhere to zero tolerance of:
Academic Misconduct, Academic Dishonesty, Professional Misconduct and Illegal Activities
The commitment to a Zero Tolerance policy fosters and upholds academic and professional integrity. It creates a safe, secure, and healthy
environment to learn and work.
Therefore, Zero Tolerance involving the above behaviors is subject to disciplinary processes up to and including dismissal from Trinitas
School of Nursing.
EFFECTIVE JANUARY 2006: If a student exits the program or if the sequence is not maintained, an application for re-entry is required. The
student must submit the application to the Dean and a minimum GPA of 2.5 is required. There is no
guarantee of re-entry into the Nursing Program. To stay active, a student not registered for courses at UCC
must submit a no- fee application form each semester.
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CLINICAL EXPERIENCE:
Most of the clinical/lab experiences will be within the Skills Laboratory where students will practice and perform health and physical
assessments. The universal patient simulator and other computerized manikins will also be utilized. If available, the instructor may use a
clinical setting at Trinitas Hospital e.g. the perioperative or gerontological units for health and physical assessment of an actual client with
a health deviation.
Course Requirements:
Completion of examinations and quizzes with a grade of ‘75’ or higher
Health/physical assessment on-line exercises/quizzes accessed through http://evolve.elsevier.com and are due as indicated on the
course calendar. Username and password will be provided by the instructor.
Demonstration of a cephalocaudal physical examination
Submission of a comprehensive written history and physical examination of an adult
Satisfactory demonstration of the following procedures:
IV therapy/IV Piggyback
Tracheostomy care and suctioning
Colostomy care
Foley catheter insertion
Wound dressing
See the Student Handbook for general information on nursing course requirements
Grading System:
1)
2)
3)
4)
5)
2 Unit exams – 15% each = 30% total
4 Quizzes – 5%
Lab Practical on psychomotor performance of cephalocaudal physical examination – 20%
Written health history and physical examination of an adult individual – 20%
Written final examination – 25%
A grade of “C+” (2.5) or better in this course is required in order to continue in the nursing sequence
Teaching Methods/Materials:
Lecture, seminar discussion, assigned readings, clinical psychomotor practice, on-line assignments, audio-visual and computerassisted instruction, writing assignment
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REQUIRED TEXTS:
Jarvis, C. (2004). Physical examination and health assessment 4th ed. Philadelphia: Saunders/Elsevier.
Jarvis, C. (2004). Student Manual of Physical Assessment 4th ed. Philadelphia: Saunders/Elsevier
Pagana, K. & Pagana, T. (2002). Mosby’s manual of diagnostic and laboratory tests 2nd ed. St. Louis: Mosby.
RECOMMENDED TEXTS:
Leonard, P. (2003). Quick and easy medical terminology 4th ed. Philadelphia: Saunders.
Venes, D. (ed) (2001). Taber’s Cyclopedic Medical Dictionary 19th ed. Philadelphia: F.A. Davis
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TRINITAS SCHOOL OF NURSING
NURE 212
BEHAVIORAL OBJECTIVES
UNIT I
Overview of Health Assessment
Given information in class, laboratory,
required readings, and planned learning
experiences, the student will be able to:
1. Discuss the role of assessment as the
starting point of clinical reasoning.
2. Identify the purpose of data collection
and physical assessment.
3. Describe the use of diagnostic
reasoning in clinical judgment.
4. Discuss the use of the nursing
process in clinical judgment.
5. Discuss the expanded concept of
health and relate it to the process of
data collection.
6. Describe the types of databases used
in different clinical situations
7. Consider growth and development
stage when evaluating health data.
8. Describe expected physical,
psychosocial, cognitive, and
behavioral milestones of a patient
based on developmental stage.
9. Discuss the basic characteristics of
culture and its role as a potential
source of conflict between nurse and
client within the health assessment
process.
10. Identify the components of the health
belief system and their influence on
health practices and illness
perception/expression.
CONTENT
Unit I
Overview of Health Assessment
A. Assessment of the whole person
1. Critical thinking in health
assessment
2. Diagnostic reasoning in clinical
judgment
3. Nursing process in clinical
judgment
B. Expanding the concept of health
1. Comprehensive assessment
factors
2. Types of databases
a. complete
b. episodic
c. follow-up database
d. emergency database
C. Assessment throughout the life cycle
1. Developmental tasks and
health promotion across the
life span
a. developmental
stages
b. developmental
screening tests
2. Hereditary influences
D. Transcultural considerations in
assessment
1. Religious beliefs and practices
2. Health-related beliefs and
practices
3. Transcultural expression of
illness
LEARNING ACTIVITIES
Unit I
Required Readings:
Jarvis, C. (2004). Physical examination and
health assessment 4th ed. Philadelphia:
Saunders.
Chapters 1, 2, 3
Student Activities:
1. Participate in discussions on the role
of assessment as a point of entry in
the ongoing process of nursing care.
2. Using a professional journal article as
a basis for identifying health
problems, describe the type of data
collection indicated: complete,
episodic, follow-up, or emergency
3. Discuss demographics of your town
and develop a list of appropriate
transcultural considerations for the
ethnic groups in your area.
4. Complete open-book quizzes at the
end of each chapter (non-graded)
5. Complete on-line assignment and
submit by the designated date on
course calendar.
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TRINITAS SCHOOL OF NURSING
NURE 212
BEHAVIORAL OBJECTIVES
UNIT II
The Interview
1. State facilitators and blockers of
effective communication.
2. Demonstrate ability to establish the
parameters for a health interview
3. Use the specified communication
techniques appropriately to gather
data.
4. State the ten traps of interviewing.
5. Discuss the meaning of common
nonverbal modes of communication.
6. Modify communication techniques
according to client’s developmental
stage, special needs or cultural
practices.
7. Discuss working with and without an
interpreter in order to overcome
communication barriers.
8. Explain the aspects of assessment
and history taking for suspected
abuse.
9. Recognize health care professional’s
role as mandatory reporters of abuse.
10. Discuss the health effects of violence.
11. Describe the use of the Abuse
Assessment Screen (AAS) when one
is screening for intimate partner
violence.
CONTENT
UNIT II
The Interview
A. Therapeutic communication
1. The process of communication
2. Techniques of communication
3. Stages of therapeutic
communication
a. initial interview
b. working phase
c. termination phase
4. Effective interviewing skills
5. Developmental considerations
a. children and
adolescents
b. the older adult
c. clients with special
needs
6. Overcoming communication
barriers
B. Cross-cultural communication
1. The professional relationship
2. Functional use of space
3. Nonverbal cross-cultural
communication
C. Domestic violence assessment
1. Health effects of violence
2. Screening for intimate partner
violence
a. assessment
b. history
c. physical exam
d. documentation
LEARNING ACTIVITIES
UNIT II
Required Readings:
Jarvis, 4th edition
Chapters 4, 5
Student Activities:
1. Paired students will role play an
interview between nurse and client
based on an identified
problem/concern that the client wants
to discuss. At the completion of the
interview, the student/client will give
feedback to the student/interviewer.
Both students should identify
facilitators and barriers. Video or
audio recorders may be used with the
permission of students involved in the
role play. Use the performance
checklist as a basis for the critique.
2. Identify local resources available for
domestic violence as well as for elder
abuse/neglect.
3. Discuss “red flags” of abuse and
neglect that may be found during an
assessment.
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TRINITAS SCHOOL OF NURSING
NURE 212
BEHAVIORAL OBJECTIVES
UNIT III
The Complete Health History
1. State the purpose of the complete
health history
2. List categories of information
contained in a health history
3. Describe the data that must be
gathered for each category of a health
history.
4. Describe the eight characteristics that
should be addressed for each
symptom identified
5. Relate the developmental
considerations to be addressed during
a health history for a child or older
adult.
6. Define the behaviors that are
considered in assessment of a
person’s mental status.
7. Describe developmental
considerations of a mental status
examination.
8. Define nutritional status
9. State the purpose of nutritional
assessment.
10. Describe the role of culture and
values in a client’s nutritional intake.
11. Identify the components of a
nutritional assessment.
12. Use anthropometric measures and
laboratory data to assess nutritional
status of clients.
13. Use nutritional assessment in the
provision of care.
CONTENT
UNIT III
The Complete Health History
A. The health history
1. Biographical data
2. Source of history
3. History of present illness
4. Past health
5. Family history
6. Review of systems
7. Functional assessment
8. Perception of health
B. Developmental considerations
1. Children and adolescents
2. The older adult
C. Mental Status Assessment
1. Defining mental status
a. developmental
considerations
b. components of
mental status
examination
2. Objective data
a. appearance
b. behavior
c. cognitive functions
d. thought processes
and perceptions
e. developmental
considerations
3. Abnormal findings
a. nursing diagnoses
LEARNING ACTIVITIES
UNIT III
Required Readings:
Jarvis, 4th edition
Chapters 6, 7, 8
Student Activities:
1. Using the School’s or the hospital’s
health history form and working in
pairs, obtain a health history from
each other.
2. Identify interviewing techniques that
were most or least helpful.
3. Search the Internet for available
mental status assessment instruments
and assess instrument for
completeness
4. Using the form provided in the text,
complete a MiniMental State
Examination on an assigned partner.
5. Complete a mental status assessment
on an assigned client. Document the
results of the assessment and
formulate associated nursing
diagnoses.
6. Complete a nutritional assessment of
a person from a different culture and
describe the nutritional implications of
the cultural values of the person.
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TRINITAS SCHOOL OF NURSING
NURE 212
BEHAVIORAL OBJECTIVES
CONTENT
LEARNING ACTIVITIES
UNIT III continued
D. Nutritional status Assessment
1. Define nutritional status
a. developmental
considerations
b. transcultural
considerations
c. dietary practices of
selected cultures
d. purposes and
components of
nutritional
assessment
2. Subjective data – health
history questions for specific
populations
3. Objective data – clinical signs
and anthropometric measures
4. Laboratory studies –
biocultural variations; serial
assessment
E. Effective documentation of findings
1. Review of systems
2. Comprehensive history
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TRINITAS SCHOOL OF NURSING
NURE 212
BEHAVIORAL OBJECTIVES
UNIT IV
BEGINNING THE PHYSICAL
EXAMINATION PROCESS
1. Describe the use of inspection,
palpation, auscultation and percussion
as physical examination techniques.
2. Differentiate between light, deep, and
bimanual palpation.
3. Discuss appropriate infection control
measures to prevent spread of
infection during physical assessment.
4. State developmental considerations in
preparing clients for physical
examination.
5. List information considered in each of
the four areas of a general survey.
6. Discuss relevant developmental
considerations in relation to a general
survey.
7. Describe correct procedures for
assessing vital signs.
8. Differentiate the different types of pain
9. Describe initial pain assessment.
10. Compare available pain assessment
tools
11. Discuss the physical changes that
may occur because of poorly
controlled pain.
12. Describe developmental, transcultural,
and gender considerations regarding
pain.
CONTENT
UNIT IV
BEGINNING THE PHYSICAL
EXAMINATION PROCESS
A. Cultivating your senses - Physical
examination techniques
1. Inspection
2. Palpation
3. Percussion
4. Auscultation
B. The clinical setting
1. Equipment
2. Safe environment
3. Approaching the client
C. Developmental considerations across
the life span.
D. General survey
1. Physical appearance
2. Body structure
3. Mobility
4. Behavior
E. Measurement – height and weight
F. Vital signs
G. Additional techniques
H. Developmental considerations
1. Infants and children
2. The aging adult
F. Transcultural considerations
G. Application and critical thinking
H. Abnormal findings
I. Pain Assessment – the 5th vital sign
1. Neuroanatomic pathway
2. Nociception
3. Sources of pain
LEARNING ACTIVITIES
Required Readings:
Jarvis 4th edition
Chapters 9, 10, 11
Student Activities:
1. Working in pairs, students will practice
the techniques used in physical
examination.
2. Practice handling an otoscope and
ophthalmoscope.
3. Practice listening to heart and lung
sounds using SimMan and on each
other.
4. Write a general survey description of
a “client”.
5. Participate in a seminar discussion of
personal pain experiences and how it
was managed.
6. Use different pain assessment tools to
rate pain.
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TRINITAS SCHOOL OF NURSING
NURE 212
BEHAVIORAL OBJECTIVES
CONTENT
LEARNING ACTIVITIES
UNIT IV
BEGINNING THE PHYSICAL
EXAMINATION PROCESS CONTINUED
4. Types of pain
a. infants
b. aging adult
5. Gender differences
6. Subjective data
a. initial pain
assessment
b. pain assessment
tools
7. Objective data
8. Documentation
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TRINITAS SCHOOL OF NURSING
NURE 212
BEHAVIORAL OBJECTIVES
UNIT V
PHYSICAL EXAMINATION
1. Demonstrate techniques used during
a physical examination
2. State adjustments which may be
necessary to accommodate cultural,
spiritual, or developmental
considerations
3. Describe equipment used in
performing examination and
observations
4. List techniques to promote physical
and psychological comfort during a
physical examination.
5. Describe proper positioning for the
client.
6. Identify differences in assessing
children, young adults, and older
adults.
7. Complete a physical assessment of
each body system in a systematic
manner.
8. Identify normal and abnormal findings
across the life span
9. Document findings in a concise,
descriptive manner using appropriate
terminology.
10. Discuss how assessment findings
influence the nursing process.
11. Describe methods to incorporate
health teaching into the physical
assessment.
CONTENT
UNIT V
PHYSICAL EXAMINATION
A. Body systems examination
1.
2.
3.
4.
5.
6.
Skin, hair and nails
Head and neck, lymphatics
Eyes
Ears
Nose, mouth, throat
Breasts and regional
lymphatics
7. Thorax and lungs
8. Head and neck vessels
9. Peripheral vascular system
and lymphatic system
10. Neurological system
11. Male/Female genitalia
12. Anus, rectum, and prostate
B. Integration of physical assessment
1. Use of critical thinking to
determine client health status
and recommendation for
health promotion
2. Incorporation of health
teaching into the physical
assessment
3. Documentation
LEARNING ACTIVITIES
Required readings:
Jarvis, 4th edition
Chapters 12 – 28
Student Activities:
1. Working in groups of three, one to
follow the checklist and textbook, one
to perform the examination, and one
to act as client, perform a physical
examination of assigned body system.
Each student will rotate roles to allow
each to be an examiner.
2. Document data obtained using the
selected History and Physical
Assessment Form.
3. View assigned Bates’ Physical
Assessment video tapes.
4. Complete a comprehensive health
assessment project.
5. Complete and submit assigned on-line
exercises.
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