Full Course Description
2 Day: Advanced Assessment Skills: Respond to the Patient's Clues with Skill and Confidence
- Integrate sound critical thinking and clinical decision-making.
- Demonstrate advanced heath assessment knowledge and skills including therapeutic communication.
- Manage a comprehensive database including functional assessment, psychological assessment, health and pharmacological history, and physical examination.
- Formulate appropriate laboratory and diagnostic testing.
- Evaluate findings of laboratory and diagnostic testing along with suggestions for treatment.
- Determine a differential diagnosis based on assessment data.
- Diagnose the area of the heart where ischemia, injury, or infarction are occurring based on 12-lead ECG.
- Choose the best interventions for stabilization of the deteriorating patient.
- Determine the key interventions to stabilize the successfully resuscitated patient.
- Analyze the latest clinical practice guidelines for common pathologies and comorbidities.
- Formulate documentation strategies to protect yourself and your practice in the case of lawsuit.
- Evaluate early signs of clinical deterioration to identify key interventions to initiate.
General Survey of the Patient: What You See is What You Get…Well Not Always
- CALM acronym: How to set the person at ease during your assessment
- Three key elements in determining the psychosocial assessment
- Proven ways to assess stress in the patient
- Two ways to quickly identify suicidal ideation
- Is this an accident or abuse or neglect?
Look Into My Eyes
- Symptom analysis…use the COLDSPA acronym
- What the blood pressure and pulse tell you about the patient…even before the stethoscope
- Four proven ways to differentiate neuropathic and non-neuropathic pain
- Key steps when a patient says that they have a condition you have never heard of
- Are the patient’s medications causing the problem…check the Beers criteria
Respiratory System…Much More than Breath Sounds
- Red-flags you must be aware of regarding the eyes
- How medications affect the eye exam
- Differentiating visual acuity and visual fields…impact of the cranial nerves
Cardiovascular System…Beyond the Heart
- Three age-related changes in the lungs you must know
- The stethoscope is vital, but so are your hands
- How to differentiate asthma, emphysema, pneumonia, and pleural effusion
- Keys to indicate the patient needs a chest radiograph
- The ABCs of ABGs: Four proven ways to contrast respiratory vs. metabolic acidosis and alkalosis
- Four other laboratory tests to assess lung function
- Medications for pulmonary conditions
Gastro-intestinal System…Beyond the Large and Small Intestine
- Determine if that adventitious sound is during systole or diastole
- Murmurs, rubs, opening snaps…what do they all mean?
- What does the ECHO cardiogram tell you?
- Identify the location of the ischemia, injury, or infarction based on the 12-lead ECG
- Laboratory tests for heart conditions…Heart failure, myocardial infarction, pericarditis
- Pearls for a thorough peripheral vascular assessment…arteries, veins, and lymph nodes
- Must-know categories of medications that deteriorate the heart
- Don’t worry about this prevalent finding…it is age related
- GI laboratory tests that are vital for patient assessment
- Could this be cancer or a normal finding?
- Four most-ordered GI procedures and differential diagnosis
- The effect of medications on the GI tract
- Differentiate cystitis, UTI, and pyelonephritis…should medications be prescribed?
- ”There is blood in my urine”; what you need to do right now for your patient
- GU laboratory test and procedures; how to interpret the results
- How contrast dyes affect the kidney…watch out for these signs
- ”I have this back pain”; what you need to do now before the pain progresses
- Differentiating muscular pain and nerve damage
- Five time-honored tests for the musculoskeletal system
- Medications that facilitate fluidity in the MS system
Assessment of the Elderly Patient
- Differentiating two- and three-reflex arcs
- Four pearls when conducting cranial nerve assessment
- Is this a motor or sensory problem?
- Two tests for meningitis which do not require cerebral spinal fluid
- Types of seizures and the latest medication options
- Four deadly infections of the neurologic system
- Does your patient need an MRI, Positron emission tomography, or CT scan?
- Neurologic monitoring: Intraventricular, intraparenchymal, brain oxygen tension
Rapid Assessment of the Decompensating Patient
- Head to toe differences in the assessment of the elderly patient
- ”I can’t seem to remember…is this normal?” Cognitive alterations occurring as we age
- These laboratory parameters differ in the elderly
- The effect of medications on the elderly
- AMPLE acronym: A must-know to quickly and accurately gather patient information
- ”I have pain”…the PQRST acronym is vital to help the patient
- Get these labs immediately for a crashing patient
- RNs, RTs, NPs, and PAs from:
- Medical-Surgical floors
- Critical Care
- Urgent Care
- Skilled Nursing Facilities
- Anyone desiring next level skills to proactively assess and intervene for their patients!
12-Lead EKG & Chest X-Ray Interpretation: Enhancing Assessment Skills for Improved Outcomes
- Analyze EKG changes associated with ischemia, injury and infarction patterns.
- Specify the features of right bundle branch block from the features of left bundle branch block.
- Evaluate axis deviation and the implications for clinical practice.
- Assess common cardiac and pulmonary disorders using the chest x-ray.
- Detect the placement of invasive lines on chest x-rays.
- Develop a systematic approach to chest x-ray interpretation.
- Incorporate the clinical pearls of EKG and chest x-ray interpretation into daily practice.
Part I: The ABCs of 12-Lead EKG Interpretation
The 12-Lead EKG
- Cardiac electrical conduction system
- Electrical vectors
- Normal polarity & P-QRS-T configuration of each lead
Ace the Axis
- Left & right axis deviation
- Causes & criteria
- Methods of determining axis deviation
- Clinical applications
Beat the Bundles
- Right & left bundle branch blocks
- Causes & complications
- Left anterior & left posterior hemiblocks
Correlate the Coronary Anatomy
- The coronary arteries
- Left ventricular walls
- Relationship to the 12-lead
Differential Diagnosis in Acute Coronary Syndrome
- Ischemia, injury & infarction patterns
- Reciprocal changes
- STEMI vs. NSTEMI
- Coronary spasm
- Takotsubo cardiomyopathy
Putting it all Together
- The 30-second diagnosis
- Coronary angiographic correlation
- Presentations, analysis & clinical applications
- Atrial & ventricular hypertrophy
- WPW – Wolff-Parkinson-White Syndrome
- Prolonged QT intervals
Part II: Chest X-Ray Interpretation as Easy as Black & White
The Chest X-Ray
- Black & white principles
- Bone structures & Intercostal spaces
- Soft tissues & vasculature
- Pleural surfaces
- Heart & great vessels
- Invasive lines
As Easy as Black
- Identifying pneumothorax & subcutaneous emphysema
- Treatment priorities
As Easy as White
- Pleural Effusion
- Pulmonary Edema
- Cardiac Tamponade
- Clinical applications & interventions
Beyond the Basics
- Identification & Initial Treatment of:
- Aortic aneurysm
- Post-op changes with pneumonectomy
- Nurse Practitioners
- Clinical Nurse Specialists
- Physician Assistants
Heart and Lung Sounds, 2nd Edition
Nurses/Nurse Practitioners/Clinical Nurse Specialists, Other Professions
- Analyze 6 extra heart sounds and distinguish what they mean when you hear them.
- Assess the difference between systolic and diastolic murmurs, as well as clues to expected assessment finding with each.
- Analyze 5 adventitious breath sounds and understand the clue and common causes for their occurrence.
- Evaluate voice sounds to confirm pulmonary pathology.
Cardiac Assessment Skills
- Extra Heart Sounds
- S2 Splits
- Summation Gallops
- Mechanical Clicks
- Pericardial friction Rubs
- Heart Murmurs
- 4 Systolic Murmurs
- 3 Diastolic Murmurs
- Adventitious Breath Sounds
- Pleural Friction Rubs
- Using Vocal Fremitus to Confirm Pathology
- Whispered Pectoriloquy