Week 3: Shadow Health Neurological Physical Assessment Assignment

Week 3: Shadow Health Neurological Physical Assessment Assignment Submit Assignment Pre Brief Two days after a minor, low-speed car accident in which Tina was a passenger, she noticed daily bilateral headaches along with neck stiffness. She reports that it hurts to move her neck, and she believes her neck might be swollen. She did not lose consciousness in the accident and denies changes in level of consciousness since that time. She states that she gets a headache every day that lasts approximately 1-2 hours. She occasionally takes 650 mg of over the counter Tylenol with relief of the pain. This case study will allow you the opportunity to examine the patient's optic nerve via use of the ophthalmoscope as well as assess her visual acuity. You will need to document your findings using appropriate medical terminology. Be sure to assess for foot neuropathy using the monofilament test. Reason for visit: Patient presents complaining of headache. Upload a file, or choose a file you've already uploaded. File: Add Another File Click here to find a file you've already uploaded  CancelSubmit Assignment Rubric Title: Shadow Health Physical Assessment Rubric Shadow Health Physical Assessment Rubric Criteria Ratings Pts Edit criterion descriptionDelete criterion row This criterion is linked to a Learning OutcomeSubjective Data, Organization, Communication, and Summary (DCE Score or transcript) Range threshold: pts Edit ratingDelete rating 25.0 pts Above Average- DCE Score greater than or equal to 93; Comprehensive introduction with expectations of exam verbalized; questions worded in a non-judgmental way; professional language exercised; questions well-organized; appropriate closing with summary of findings verbalized to patient. Edit ratingDelete rating 21.0 pts Average- DCE Score greater than or equal to 86-92; Adequate introduction; some questions worded in a non-judgmental way; professional language mostly exercised; questions generally organized; somewhat complete closing. Edit ratingDelete rating 10.0 pts Below Average- DCE Score greater than or equal to 80-85; Incomplete introduction; many questions worded in a judgmental way; some professional language exercised; questions somewhat organized; incomplete closing. Edit ratingDelete rating 0.0 pts Unsatisfactory- DCE Score less than or equal to 79; Introduction missing; questions worded in a judgmental way; little professional language; questions unorganized; closing missing. pts 25.0 pts -- Edit criterion descriptionDelete criterion row This criterion is linked to a Learning OutcomeObjective Data, Physical Examination, Interpretation of Findings, Assessment, and Documentation Range threshold: pts Edit ratingDelete rating 20.0 pts Above Average- Physical assessment documentation includes all relevant body systems; all pertinent normal and abnormal findings identified; documentation reflects professional language; treatment plan includes each of the following components: diagnostics, medication, education, consultation/referral, and follow-up planning. Edit ratingDelete rating 16.0 pts Average- Physical assessment documentation lacks sufficient details pertaining to one or two relevant body systems; or identifies ≥ 50% of the pertinent normal and abnormal findings; or documentation lacks professional language; or treatment plan lacks one or two components (diagnostics, medication, education, consultation/referral, or follow-up planning). Edit ratingDelete rating 8.0 pts Below Average- Physical assessment documentation lacks sufficient details pertaining to three or more relevant body systems; or identifies 49% of the pertinent normal and abnormal findings; or documentation includes unprofessional language; or treatment plan lacks three or more components (diagnostics, medication, education, consultation/referral, or follow-up planning). Edit ratingDelete rating 0.0 pts Unsatisfactory- No physical assessment documentation or no treatment plan. pts 20.0 pts --