FNP Student Skills Check Off
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1 FNP Student Skills Check Off At Loyola, the Advanced Health Assessment (AHA) courses are the first steps in becoming acclimated to the role of Primary Nurse Practitioner. In preparation for their new role, FNP students are required to go through different Advanced Health Assessment stations, where they will learn new assessment skills, such as how to use an otoscope and ophthalmoscope. Students will also have their RN Head to Toe Assessment skills verified and will be required to successfully complete a Head to Toe exam on a partner in order to begin clinicals. The following pages contain a sample of the grading criteria. Please practice and come prepared to complete the Head to Toe exam without prompting or note cards. Students who are not successful will be given one (1) additional opportunity to demonstrate proficiency. Tools to Bring: Stethoscope Penlight Reflex Hammer What to Wear: Loose, comfortable clothing. Students will be conducting physical exams on one another. Dates & Times: Students will receive an containing meeting dates at the time of registration. Dates will also be posted to the School of Nursing Resources webpage. Required Textbooks: Students will receive an containing textbook(s) required for Advanced Health Assessment at the time of registration. If you have any questions, please contact Jennifer Brackett, the DNP/MSN Administrative Assistant, at brackett@loyno.edu.
2 College of Nursing and Health BSN DNP, MSN-FNP, and MSN-NE Program RN PHYSICAL EXAM REQUIREMENTS Student s name: Evaluator: Grade: Date: Students will complete a physical assessment on a fellow student, meeting all of the objective points indicated on this Physical Exam Performance Checklist. Please wear comfortable, loose clothing as you will examine a fellow student. Student is expected to complete the exam in a strictly timed 30 minute period. You will need a stethoscope, penlight, and reflex hammer to complete the physical exam. Students Approach to Patient Logical Exam Sequence (-2) Yes No Comments Initiated / Ended Exam well (-1) Explained exam to patient (-1) Assembled proper equipment (-1) Provided for privacy (-1) Professional, and mature (-2) Used correct terminology and pronunciation (-2) Students may lose up to 10 points for inappropriate demeanor and behavior PROCEDURE Yes No Points CARDIAC & THORACI THORACIC Inspect anterior, posterior, lateral, chest wall 1.0 Respiratory rate, rhythm, and effort (retractions, use of 1.0 accessory muscles) Palpate for chest wall (for tenderness, lesions)
3 CARDIAC & CIRCULATION Thoracic expansion (anterior/posterior) 1.0 Percussion (anterior, posterior, and lateral) from apex to base (note resonance, hyperresonance, dullness) Auscultation of breath sounds from apex to bases (posterior, anterior, lateral-sitting) Inspection of the precordium. Describes 6 areas of 3.0 assessment (aortic, pulmonic, Erb's, Tricuspid, Mitral, epigastric) Palpation of precordium for any heave, thrill, PMI, pulsations. Auscultation of the heart (supine, left lateral, sitting position with diaphragm and bell) Inspection, palpation and auscultation of carotids. Location of palpable pulses (radial, brachial, dorsalis, posterior tibia, popliteal). SUBTOTAL CARDIAC & THORACIC WORTH 20 POINTS 20 HEAD, EARS, EYES, NOSE, THROAT (HEENT) GENERAL OVERVIEW AND SKIN Inspect & Palpate skin (turgor, texture, temperature) 1.0 Hair - inspect 1.0 Nails - inspect and palpate (clubbing, cap refill) HEAD & NECK Palpate head and scalp, including sinuses and TMJ EYES EARS Palpate and auscultate temporal arteries; Inspect neck and neck veins Palpate Neck: Trachea Thyroid Lymph nodes (all sets in neck - state which ones) Inspection of eyebrows, eyelids, orbital area, eyelashes, 1.0 lacrimal gland Palpation of orbital area (sclera, conjunctiva) 1.0 Direct and Consensual Response Inspection and palpation of ear & functional hearing NOSE Inspect external nose & internal nares MOUTH Inspect lips, teeth, buccal mucosa, tongue, floor of mouth SUBTOTAL HEENT WORTH 20 POINTS 20.0 ABDOMEN Inspection of the abdomen (supine position, pillow under head, arms at side, empty bladder) 3.0
4 Auscultation of all quadrants: 3.0 bowel sounds, aortic, iliac, femoral, and renal arteries. Percussion of abdomen in 4 quadrants Percussion of liver span at MCL 3.0 Percussion of splenic dullness Light & Deep palpation of 4 quadrants CVA and rebound tenderness 3.0 Palpate aortic pulsation SUBTOTAL ABDOMEN WORTH 20 POINTS 20.0 MUSCULOSKELETAL OVERVIEW Inspect joints and muscles 1.0 ROM Neck - Flexion, extension, lateral bending and rotation (Assessment of head and neck may be done with head and neck exam.) Shoulder - Adduction, abduction, internal rotation, and external rotation Elbow - Flexion and extension, supination pronation Wrist - Flexion and extension, ulnar and radial deviation Fingers - Flexion and extension, adduction and abduction Hip - Internal and external rotation, flexion, extension, adduction and abduction Knee Flexion and extension Ankle - Plantar and dorsiflexion 1.0 Vertebral column - Flexion, extension, rotation, and lateral bending STRENGTH Neck, Shoulder, Elbow, Hands, Hips, Knees, Ankle SUBTOTAL 4 MUSCULOSKELETAL WORTH 20 POINTS 20.0 NEUROLOGICAL OVERVIEW Cognitive abilities (memory) 1.0 CRANIAL NERVES Judgment, abstraction 1.0 Fields of peripheral vision CN II - Optic Pupil condition and response to light and accommodation CN II (Optic), and III (Oculomotor) Extra ocular movement (six cardinal fields) CN III (Occulomotor), IV (Trochlear), and VI (Abducens) Assess CN V - Trigeminal- Motor and Sensory
5 REFLEXES (DTRS) CEREBELLAR Assess CN VII Facial - Motor only whisper test) CN VIII - Acoustic Observe movements of soft palate CN IX (Glossopharyngeal) and X (Vagus) Assess CN XI - Spinal accessory Inspect tongue for movement - CN XII - Hypoglossal Upper extremities (biceps, triceps, brachioradialis) 1.5 Lower extremities (patellar, Achilles, Babinski, clonus) 1.5 Sensation (light touch) using LE and UE 1.0 Coordination (finger to nose, nose to finger, alternating, 1.0 rapid hand patting) Pronator drift 1.0 Gait: Tandem walking SUBTOTAL NEUROLOGIC SYSTEM WORTH 20 POINTS 20.0 CARDIAC AND THORACIC HEENT ABDOMEN MUSCULOSKELETAL NEUROLOGICAL TOTAL Total possible points = 100
6 College of Nursing and Health School of Nursing Practicum Skills Checklist Students should demonstrate skills & provided rationale for choice of exam/test during their clinical rotation and during the site visit with FNP faculty Course faculty will be responsible for making the final determination regarding course grade after conducting the site visit and consulting with the preceptor. This checklist provides a guide for minimum competencies required in the program 812 AHA Prac 830 Primary Care Peds Prac 845 Primary Care of Adults Prac 855 Primary care of Adults & Women Prac Spring Intensive Grading Key O= observed but not competent C= observed & competent in skill Complete Head-to-toe History and Physical Exam (Annual Adult Wellness/Preventive Exam) Episodic History and Physical Exam Complete HEENT Exam Complete Cardiovascular Exam Inspection (pulsations, lifts, heaves, retractions, skin lesions, venous distention, surgical scars, tattoos, JVD) Palpation (precordium, apical pulse, pulsations, lifts, heaves, retractions) Pulses (Apical, radial, femoral, temporal, carotid, brachial, radial, popliteal, posterior tibial, dorsalis pedis) Peripheral lymph nodes Evaluation of Edema Auscultation for bruits Heart Sounds (aortic, pulmonic, Erb s Point, Tricuspid, Mitral) Identification of Heart Murmur Complete Respiratory Exam Inspection Auscultation Palpation Percussion 1
7 College of Nursing and Health School of Nursing Complete Neurologic Exam including: Mental Status (mood, affect, thought processes, cognitive functions) Cranial Nerve Exam I-XII Cerebellar Exam Coordination/Cerebellar Function (alternating hands movements, touch thumb to each finger, finger to examiner s finger bilat, touch nose with index finger, pronator drift, heel to shin) Proprioception (Romberg test, stand on one foot, walk, heel-toe walk, walk on toes, walk on heels) Motor Exam (Hand grips and strength testing) Sensory Exam Pain (Sharpness/Dullness) Vibratory Sensation Position of joints Stereognosis Two point discrimination Deep Tendon Reflexes (UE & LE) Plantar bilateral Clonus (present or absent) Complete Gastrointestinal Exam Inspection (striae, Cullen sign, distention, hernias, masses) Auscultation (bruits, renal, aorta, iliac femoral) Percussion (liver span, spleen, gastric bubble, CVA tenderness) Palpation (Murphy s sign, McBurney s point, iliopsoas muscle test, obturator muscle test, abdominal reflexes, rebound tenderness, ballottement) Complete Musculoskeletal Exam (upper extremities) Temporalmandibular joint, cervical spine, thoracic, lumbar spine, shoulder, elbow, wrist/hand assessment Spurling s Test, Apley Scratch Test, Painful Arc Test, Apprehension Sign, Hawkins test, Identify the Snuff Box, Finkelstein s Test, Phalen s Test, Tinel Test, ROM, muscle tone Complete Musculoskeletal Exam (lower extremities) Hip, knee, ankle, foot Trendelenburg Test, Anterior/Posterior Drawer Sign, McMurray Maneuver, Lachman Test, Anterior/Posterior Drawer Test, Talar Tilt Test, Thomas Test, Straight Leg Raise/Crossed Straight Spring Intensive 2
8 College of Nursing and Health School of Nursing Leg Raise, Bulge sign, Ballottement test, ROM, muscle tone/strength Pediatric PE Infant (review with parent/pt guardian-growth charts and developmental screening) Pediatric PE Toddler (review with parent/pt guardian-growth charts and developmental screening) Pediatric PE Child (review with parent/pt guardian-growth charts and developmental screening) Pediatric PE Adolescent (review with parent/pt guardian-growth charts and developmental screening) N 812 N 830 N 845 N 855 Spring Intensive Pre-participation physical Laboratory Evaluation (includes interpretation): CBC CMP Lipid panel Thyroid panel Hepatic function panel UA and Culture Breast exam Pelvic Exam Prostate Exam Testicular Exam Basic Chest X-ray Interpretation lecture Basic EKG interpretation lecture Basic Suturing Basic Splinting & Extremity X-rays Additional Skills Saline wet mount Potassium hydroxide (KOH) prep Woods lamp Pulmonary function tests (evaluate) Peak flow (obtain from patient during encounter) Spirometry Routine eye exam- Snellen chart Routine eye exam-rosenbaum Fluorescein staining of eyes Tonometry Tymapnometry tests Audiometry
9 College of Nursing and Health School of Nursing Developmental screenings Growth charts Pap smears Portable Doppler (please identify purpose for Doppler evaluation) Suturing Incision and drainage Dermabond Staple removal Chemical cautery/liquid nitrogen Cerumen removal Ring removal (removal of ring from finger) Cognitive testing Mini mental exam PHQ2 and PHQ9 GAD-7 Screening for ETOH use Screening for Intimate Partner Violence 4
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