Musculoskeletal Focused Note
For this Assignment, you will work with a patient with a musculoskeletal condition that you examined during the last three weeks. You will complete your third Episodic/Focused Note Template Form for this course where you will gather patient information, relevant diagnostic and treatment information as well as reflect on health promotion and disease prevention in light of patient factors such as age, ethnic group, previous medical history (PMH), socio-economic, cultural background, etc. In this week’s Learning Resources, please review the Focused Note resources for guidance on writing Focused Notes.
Note: All Focused Notes must be signed, and each page must be initialed by your preceptor. When you submit your Focused Notes, you should include the complete Focused Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your Focused Notes using Turnitin.
Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
To prepare:
- Use the Episodic/Focused Note Template found in the Learning Resources for this week to complete this assignment.
- Select a patient that you examined during the last three weeks based on musculoskeletal conditions. With this patient in mind, address the following in a Focused Note:
Assignment:
- Subjective: What details did the patient provide regarding her personal and medical history?,
- Objective: What observations did you make during the physical assessment?,
- Assessment:What were your differential diagnoses? Provide a minimum of three possible diagnoses., List them from highest priority to lowest priority. What was your primary diagnosis and why?,
- Plan:What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management including alternative therapies?, Include pharmacologic and nonpharmacologic treatments alternative therapies and follow-up parameters as well as a rationale for this treatment and management plan.,
- Reflection notes:What would you do differently in a similar patient evaluation?
Note: Your Focused Note Assignment must be signed by Day 7 of Week 9.
By Day 7
Submit your Episodic/Focused Note Assignment.
(Note: You will submit two files, your Focused Note Assignment, and a Word document of pdf/images of each page that is initialed and signed by your preceptor by Day 7 of Week 9.)
submission information
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as WK9Assgn2_LastName_Firstinitial
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
Rubric
PRAC_6531_Week9_Assignment2_Rubric
| PRAC_6531_Week9_Assignment2_Rubric | ||||||
| Criteria | Ratings | Pts | ||||
| This criterion is linked to a Learning OutcomeOrganization of Write-up |
|
10 pts | ||||
| This criterion is linked to a Learning OutcomeThoroughness of History |
|
20 pts | ||||
| This criterion is linked to a Learning OutcomeHistory of Present Illness |
|
10 pts | ||||
| This criterion is linked to a Learning OutcomeThoroughness of Physical Exam |
|
10 pts | ||||
| This criterion is linked to a Learning OutcomeDiagnostic Reasoning |
|
10 pts | ||||
| This criterion is linked to a Learning OutcomeTreatment Plan/Patient Education |
|
20 pts | ||||
| This criterion is linked to a Learning OutcomePatient Education / Follow Up / Reflection |
|
10 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting English writing standards: Correct grammar, mechanics, and proper punctuation. Professional language utilized |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeScholarly References and Clinical Practice Guidelines. The assignment includes a minimum of 3 scholarly references that are not older than 5 years. Clinical practice guidelines are included if applicable. |
|
5 pts | ||||
| Total Points: 100 | ||||||
