NR 305 Neurovascular Assessment: Athena Washington (iHuman) (Graded)

NR305 Week 4 iHuman Nurse Notes Template 

Sample Answer for NR 305 Neurovascular Assessment: Athena Washington (iHuman) (Graded) Included After Question

Week 4 Neurovascular Assessment: Athena Washington

Name:

Date: 1^st October 2023

1. Complete each item below:  

Situation

• Ms. Athena Washington, a 48-year old African American female with a history of hypercholesterolemia and hypertension presents to the ER with stroke-like symptoms. As reported by her husband (informant), yesterday at 1830hrs, she had a severe headache, she took tylenol and slept. At 0500hrs, she woke up with disorientation, left-sided weakness, and slurred speech. Ms. Athena has a full code status, and condition is critical.  

Background

• Ms. Athena Washington has hypercholesterolemia and poorly controlled hypertension. She takes the following medications; acetaminophen 650mg PO PRN for pain, metoprolol 50mg PO BID, and simvastatin 40mg PO nocte. Ms. Athena has an uptodate immunization status, she lives with her husband, and has no known allergies.  She has two children; the eldest daughter has type 1 diabetes mellitus, and the youngest son is alive with no medical issues.

Assessment

BP: 180/110mmHg

Pulse: 110bpm

RR: 24 breaths/cycle

Temp: 37.00c

HEENT: Head: atraumatic, normocephalic, no lesions, bruising, or palpable masses. Ears: hearing bilaterally intact, no fluid or inflammation in external auditory canal, TM intact. Eyes: PERRLA. Nose & Throat:

Cardiovascular: S1 & S2 heard, no JVD, capillary refill <3 seconds, no murmurs, rubs, gallop rhythm, or bruits, pulses 2+ in the radial, brachial, pedal, and femoral, no peripheral or facial edema noted, PR 110 (tachycardia)

Respiratory: chest moves symmetrically with respiration, no use of accessory muscles, no abnormal retractions, no crackles, rhonchi, or wheeze auscultate. Chest is bilaterally clear on auscultation.

Gastrointestinal: flat abdomen, no scars, lesions, or protruding masses, normoactive bowel sounds on all quadrants, no guarding, tenderness or rebound tenderness.

Musculoskeletal: right extremities strength 5/5, left extremities strength 2/5, leg raise LLE up to 30⁰ and patient unable to maintain in the air, RLE-no drift, right hand grip 5/5, left hand grip patient unable to perform.

CNS: AOX2 (self, husband, and place), sensation is intact, patient unable to swallow, gag reflex is present, patient can only shrug right shoulders, patient has tongue deviation, left-sided facial droop and unable to provide a symmetrical smile, sensory sensation is intact. NIH stroke score-11, Head CT scan demonstrates an acute right cerebellar infarct.

Integumentary: skin color is consistent with ethnicity, normal skin turgor, no lesions, wounds, swellings, or bruises

Recommendation

• Patient to stay NPO until she undergoes a swallow study by a speech/language pathologist
• Conduct NIH stroke evaluation Qhourly
• Occupational therapy for Activities of Daily Living (ADLs)
• Patient to undergo speech therapy
• Consult cardio for hypertension (HTN)
• Strictly monitoring of I/O, continuous telemetry and pulse oximetry.
• Monitor vitals q15
• Consult neuro for stroke
• Elevate HOB at 30 degrees
• The patient’s and patient’s family current status is likely associated with anxiety, depression, and lack of control. Therefore, she will also need the intervention of a psychotherapist.
• Gradual administration of the prescribed antihypertensives to gradually lower blood pressure.
• Teach the patient and her family the need for medication adherence
• Ask for and identify any existing knowledge gaps and address them.
• Identify two other healthcare team professionals with whom you would collaborate when caring for Ms. Washington.  
• Speech/ language therapist
• Physical therapist
• In a one paragraph response, what findings in your iHuman assessment led you to select these two providers?

Stroke patients often experience problems in communication, and motor loss/ control of movement resulting from hemiplegia (Le Danseur, 2020). Similarly, the patient Athena Washington presented with a history of slurred speech, inability to swallow, left-sided weakness with limitations in movement, which are stroke symptoms. To support this history, the physical exam was significant for dysarthria, left sided facial droop, a failed swallow screen, left leg and arm weakness, and other cranial nerve deficits. In order to improve Athena’s overall quality of Life (QoL), she will need further evaluation and management by a speech/language therapist, and physical therapist.

• The role each of the two identified healthcare professionals

Generally, the roles of the speech and physical/occupational therapist will be to assist Ms. Athena become as independent as possible and improve her overall quality of life (QoL). This will happen in a way that motivates and preserves the dignity of Ms. Athena to relearn basic skills. The speech/language therapist will work closely with the patient and her family to further assess her speech, cognitive communication, language, voice, and ability to swallow. He/she will then develop Athena’s individualized management plan to help her attain the highest level of language and communication possible (Gerstenecker & Lazar, 2019). This plan will include determining whether Ms. Athena can take medications orally, and the appropriate diet. The physical therapist will assess Ms. Athena’s problems with movement and balance and recommend muscle strengthening exercises to stand, walk, among other movement activities.

References

Gerstenecker, A., & Lazar, R. M. (2019). Language recovery following stroke. The Clinical Neuropsychologist, 33(5), 928-947. https://doi.org/10.1080%2F13854046.2018.1562093

Le Danseur, M. (2020). Stroke rehabilitation. Critical Care Nursing Clinics, 32(1), 97-108. https://doi.org/10.1016/j.cnc.2019.11.004

Purpose

The purpose of this assignment is for learners to demonstrate completing a neurovascular assessment on a virtual patient.

Course Outcomes

This assignment enables the student to meet the following course outcomes:

• CO 1: Demonstrate a head to toe physical assessment. (PO 1)
• CO 2: Differentiate between normal and abnormal health assessment findings. (PO 4)
• CO 4: Demonstrate effective communication skills during health assessment and documentation. (PO 3)
• CO 5: Identify collaborative opportunities for health promotion, risk reduction, and disease prevention. (POs 1, 2)
• CO 6: Demonstrate professional behavior and caring during patient interactions. (POs 6, 7)

Due Date

Sunday 11:59 p.m. MT at the end of Week 4

Total Points Possible

This assignment is worth 150 points.

• 100 points – Case Completion
• 50 points – Nurse Notes Responses

Late Assignment Policy

If the assignment is not submitted by due date, a late deduction will be applied. See rubric below.

Directions

1. Access the Athena Washington case assignment by locating the case in the Week 4 Module menu under Application to Practice. If prompted, select to load the case in a new browser window. Note: it may take a few moments for iHuman cases to load in our web browser.
2. Select Proceed and begin by answering the Prework questions. Your prework answers are not graded. The questions are intended to get you thinking about the case. You will continue to select the Proceed button to move you through the entire case.
3. Begin the case and complete these sections: (100 points total, immediate feedback/grade will be provided to you by iHuman when complete)
   • EHR Review
   • Health History
   • Physical Assessment
   • Note: there is no time limit on completing cases
4. As you move through your first attempt and once you complete the case, you will receive feedback from the “Expert” on the important findings that you included (or should have included), and information that should have been collected on the health history and physical assessment. The system will also tell you if you asked questions or performed assessments that are considered extraneous or inappropriate for that particular case. Review this information carefully and take notes to be used on your second attempt, if you would like to work toward a higher score.
5. If you must leave the case for any reason before you have totally completed it, the program will save your spot and will return you to the same point when you re-enter the case. (Look for the green “Resume” arrow at the bottom of the screen.) If you had fully completed a section, you will be able to review the section, but you will not be able to change your answers. You will only be able to move forward in the case.
6. Nurse Notes (50 points) are completed outside of iHuman and are graded by your instructor. To complete the Nurse Notes, download and save the required template below under Template. Rename the template as Your Last Name Week 4 Nurse Notes. This must be saved as a Microsoft Word document (.docx). Save it to your computer or flash drive in a location where you will be able to retrieve it later. Type your answers directly on the saved document. When your Nurse Notes answers are completed, save and close the template. Click the Submit button at the top of this page to upload your completed assignment. 
7. When you have completed a case review the final score and feedback provided by iHuman. You have the option to complete this case a second time before the submission deadline (total of 2 attempts) to improve your score. Your instructor will convert your highest score in iHuman to points earned in the grading rubric. Scores are adjusted based on your performance level. (See grading rubric.)

Template

Week 4 Nurse Notes TemplateLinks to an external site.

iHuman Support

Click the blue question mark icon at the bottom right of your iHuman screen at any time to access iHuman Resources. A menu will appear to assist with trouble shooting. Click “Help” from the menu to contact iHuman Support.

**Academic Integrity**

Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.

By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment.

Rubric

iHuman Case Assignments – Rubric

Criteria	Ratings	Pts
This criterion is linked to a Learning Outcome iHuman ScoreInstructor to enter student’s highest score achieved for the iHuman Case here.	100 pts i-Human score of 90-100 90 pts i-Human score of 80-89 80 pts i-Human score of 70-79 70 pts i-Human score of 60-69 60 pts i-Human score of 50-59 50 pts i-Human score of 40-49 40 pts i-Human score of 30-39 30 pts i-Human score of 20-29 20 pts i-Human score of 10-19 0 pts No Score	100 pts
This criterion is linked to a Learning Outcome SBAR Note1.All components of SBAR (Situation, Background, Assessment, Recommendations) addressed; 2. Appropriate information in each section; 3. All key findings mentioned; 4. Data is well organized and concise.	20 pts All four criteria met. 1. All components of SBAR (Situation, Background, Assessment, Recommendations) addressed; 2. Appropriate information in each section; 3. All key findings mentioned; 4. Data is well organized and concise. 18 pts One criterion is missing. 16 pts Two criteria are missing. 8 pts Three criteria are missing. 0 pts All criteria are missing.	20 pts
This criterion is linked to a Learning Outcome Paragraphs1.Thoroughly answers the questions in a detailed manner. 2. Fully demonstrates an understanding of ongoing patient needs. 3. Response includes specific resources or references as requested in the questions.	20 pts All criteria met 1.Thoroughly answers the questions in a detailed manner. 2. Fully demonstrates an understanding of ongoing patient needs. 3. Response includes specific resources or references as requested in the questions. 18 pts Answers the questions and demonstrates understanding of ongoing patient needs. Response includes specific resources or references as requested in the questions. Answer is not detailed. 16 pts Partially answers the questions and partially demonstrates understanding of ongoing needs. Resources or references included but are not specific to this case. 8 pts Minimally answers the questions and minimally demonstrates knowledge and understanding of course concepts. No resources or references included. 0 pts Did not answer the questions.	20 pts
This criterion is linked to a Learning Outcome Clarity of Writing1.Excellent mechanics; 2. Well organized, clear, and logical; 3. Professional writing style; 4. Proper grammar, punctuation, and spelling.	10 pts All criteria met 1.Excellent mechanics; 2. Well organized, clear, and logical; 3. Professional writing style; 4. Proper grammar, punctuation, and spelling. 8 pts One criterion is missing. 6 pts Two criteria are missing. 4 pts Three criteria are missing. 0 pts All criteria not met.	10 pts
This criterion is linked to a Learning Outcome Late Deduction	0 pts 0 points deducted Submitted on time. 0 pts Not Submitted on Time – Points deducted 1 day late= 7.5 deduction; 2 days late= 15 deduction; 3 days late= 22.5 deduction; 4 days late= 30 deduction; 5 days late= 37.5 deduction; 6 days late= 45 deduction; 7 days late= 52.5 deduction	0 pts
Total Points: 150

A Sample Answer For the Assignment: NR 305 Neurovascular Assessment: Athena Washington (iHuman) (Graded)

Title: NR 305 Neurovascular Assessment: Athena Washington (iHuman) (Graded)

I am completing the simulations with more confidence than the previous cases. I felt knowledgeable about the appropriate questions to ask during the history assessment. This was the first case that I asked all the correct questions according to the expert. I asked a lot of questions about habits and lifestyle which put Ms. Washington at risk for more damage in the future. The scenario was very realistic to me. I have seen how quickly a suspected stroke patient is triaged and sent for imaging in practice and the scenario seemed to follow the real-life protocols. The questioning about onset of symptoms and NIH Stroke Assessment score helped to guide my questions just like I would if she were my patient.

Next time, I would familiarize myself on the cranial nerves and study which body parts are linked to the appropriate location in the brain. I thought that I had plenty of room for improvements. I realize now that I really do not have a whole lot of experience with stroke patients and need to keep up with the most up to date protocols. This simulation took me longer to complete due to my lack of experience. I read through the feedback carefully so that I could learn where my weaknesses were. The neuro assessment was not a strongpoint. I was surprised that I missed how often the NIH Assessment needed to be completed. Now I understand it is to be done every hour. 

I learned how to be a more thorough nurse when completing my assessments on stroke symptomology. I need to pay close attention to detail and make sure I am ensuring that all orders are completed on the timeline for best outcomes. I need to involve a team approach for care and ensure collaborative communication between all healthcare providers. At the end of this assessment, I was wanting to call lab and imaging to complete the outstanding orders and get the ball rolling. This was a great opportunity to self-reflect on time management skills. I feel much better on my ability to care for a stroke patient.