Obtain a health history and conduct a physical examination

Obtain a health history and conduct a physical examination.

PREPARING THE ASSIGNMENT
There are four graded parts to this assignment: (1) Obtain a health history and conduct a physical
examination on an individual of your choosing (not a patient), (2) compile a health education needs
assessment, (3) self-reflection, and (4) writing style and format.
Instructions for each part follow.
Health History Assessment and Physical Assessment (50 points)
 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
Chamberlain College of Nursing NR304 Health Assessment II
NR 304 RUA Grading Rubric and Grading Criteria V1.docx 10_16 SMa Revised 05/31/17 SP/nlh 2
NR304. Please be sure to avoid the use of any identifiers in preparing the assignment. Students
may seek input from the course instructor on securing an individual for this assignment. Keep
notes on each part of the health history and physical examination as you complete them so that
you can refer to the notes as you write the paper.
1. Subjective Data—Health History Components to Be Included
• Demographic data
• Reason for care (why they are in the facility)
• Present illness (PQRST of current illness)
• Perception of health
• Past medical history (including medications, allergies, and vaccinations and
immunizations)
• Family medical history
• Review of systems
• Developmental considerations
• Cultural considerations
• Psychosocial considerations
• Presence or absence of collaborative resources (community, family, groups, and
healthcare system)
***REMEMBER: Make notes of the health history findings, ensuring that you have addressed all of the
components listed here. Students are also encouraged to take notes about their experiences while
conducting the health history for reference when creating the assignment, particularly the reflection section.
2. Objective Data—Physical Exam Components to Be Included
 During the lab experiences, you will conduct a series of physical exams that includes the
following systems.
 Keep notes on each part of the physical exam as you complete them to reference as you write
the paper.
 Refer to the course textbook for detailed components of each system exam. Remember,
assessment of the integumentary system is an integral part of the physical exam and should be
included throughout each system.
 From NR302
o HEENT (head, eyes, ears, nose, and throat)
o Neck (including thyroid and lymph chains)
o Respiratory system
o Cardiovascular system
 From NR304
o Neurological system
o Gastrointestinal system
o Musculoskeletal system
o Peripheral vascular system
Chamberlain College of Nursing NR304 Health Assessment II
NR 304 RUA Grading Rubric and Grading Criteria V1.docx 10_16 SMa Revised 05/31/17 SP/nlh 3
***REMEMBER: Make notes of the physical examination findings, ensuring that you have addressed all of the
components listed on the Return Demonstration Checklist. Students are also encouraged to take notes
about their experiences while conducting the physical examination for reference when creating the
assignment, particularly the reflection section.

Obtain a health history and conduct a physical examination

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