Complete a health history and physical examination on an individual. This individual must be different from the individual used for the NR302 health history and physical examination assignment.
Preparing the assignment Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.
- Complete a health history and physical examination on an individual. This individual must be different from the individual used for the NR302 health history and physical examination assignment. Using the following subjective and objective components, as well as your textbook for explicit details about each category, complete a health history and physical examination on an individual. You may choose to complete portions of this assignment as you obtain the health history and perform the physical examination associated with the body systems covered in NR304. The person interviewed must be 18 years of age or older. Please be sure to avoid the use of any identifiers in preparing the assignment and follow HIPAA protocols.
a. Students may seek input from the course instructor on securing an individual for this assignment.
b. Avoid the use of client identifiers in the assignment, HIPAA protocols must be utilized.'
c. During the lab experiences, you will conduct a series of physical exams that includes the systems listed in Objective Data below.
d. Refer to the course textbook for detailed components of each system exam. 1) Remember, assessment of the integumentary system is an integral part of the physical exam and should be included throughout each system.
& Keepnotes on each part of the health history and physical examination ss you complete them so that you can
refer tothe notes as you write the paper, particularly the reflection section
f. Utlize proper medical terminology.
3. Include the following sections, used as section headers within the paper.
2. Health History: Subjective Data (30 point 30% 1-2 paragraphs nength])
- Demographic dats
- Reasonforaare
3). Presentillness(PRST of current ness) - Perception of health
5). Past medical history (including medications, allergies, and vaccinations and immunizations) - Family medica history
- Reviewof systems
- Developmental considerations use Erikson’ Stages of Psychosocial Development which stage fs your
participant at and give examples of i they have met or not met the milestones fo tha stage. - Cultural consideratons-definiton, cultural traditions, cultural viewpoints on healng/lers, racitional and
complementary medicine, these are examples but pease add more - Psychosocial considerations- support systems family, religious, Occupational community these are examples
but please acd more - Presence or absence of collaborative resources (community fami, groups, and healthcare system)
©. Physical Examination: Objective Data (30 points/30% [1 paragraph])|
1). From NR302
a) HEENT (hea eyes, ears, nose, and throat)
b] Neck (including thyroid and lymph chains)
© Respiratory system
d) Cardiovascular system - FromNR30S
a) Neurological system
b) Gastrointestinal system
© Musculoskeletal system
dl Peripheral vascuiar system
© Needs Assessment (20 points/20% [2 paragraph) - Based on the health history and physical examination findings, determine at leat two health education
needs or the individual. Remember, you may identify an educational topic that s focused on wellness. - Support theidentified health teaching needs selected with evidence from two curren, peer-reviewed
journal artices.
3). Discuss how the nterreationships of physiological, developmental, cultura, and psychosocial considerations
wil infuence, asi, or become barriers to the effectiveness of the proposed health education.
4). Describe how the ndiiduar’s strengths (personal, family, an fiends) and collaborative resources (lca,
community, and health and wellness resources) effect proposed teaching.
a. Refiection (10 pints/10% [1 paragraph)
Reflection i used 0 intentionally examine our thought processes, actions, and behaviors in order 0
evaluate outcomes. Provide a writen reflection tht describes your experience with conducting this
complete alt isory and physica assessment. - Reflect on your interaction with the ntenveviee hlisticaly.
a) Describe th interaction i its entirety: include the environment, your approach to the individual,
time of day, and other features relevant to therapeutic communication and to the interview process - How did your interaction compare to what you have earned?
- Wnatbarriers to communication did you experience?
a) How did you overcome them?
Bl What vill you do to overcome them inthe future? - Whatvient well with this assignment?
5) Were there unanticipated challenges during this assignment?
6) Was there information you wished you had available but did not?
7) How will you alter your approach next time?
Writing Style and Format (10 points/10%)
1) Writing reflects synthesis of information from prior learning applied to completion of the assignment.
2) Grammar and mechanics are free of errors.
3) Able to verbalize thoughts and reasoning clearly.
4) Use appropriate resources and ideas to support topic with APA where applicable.
5) HIPAA protocols followed.