NR509 – Advanced Physical Assessment

Let me tell you this first. If you are computer savvy, this is going to be a breeze through class beside the Immersion. I have a separate page specifically written for the Immersion.

Also, you may want to start watching the head-to-toe video daily.

Below is the syllabus during Sep 2020.

This class is heavily focused on virtual health assessment called Shadow Health. Among peers, you will talk about this one particular person a lot, Tina Jones. She is the virtual patient that you will encounter most of the time. Here is how you get there.

In the Week 1 module, you will see this.
Then, this will show up.
Click the blue bar. Then, this shows up.
Then this…
Walla~ you finally arrived! The rest of the part is quite self-explanatory. I will skip that.

Starting from Week 1, you will be doing the following for almost every week.

1. Shadow Health – Physical assessment
2. Weekly quiz
3. Debriefing or Alternate assignment
4. APEA 3P Exam

Shadow Health
As I mentioned, Shadow Health is a virtual health assessment program that you get to practice prior to the practicum. Let me tell you from the beginning. It’s a quite dragging assignment that repeats over and over again. Once you get hang of it, it’s easy. It’s just time-consuming.

In order to do the assignment, you should have a microphone since you will be talking to the virtual patient, Tina Jones. If you don’t have a microphone, I strongly suggest you get one as you do not want to type the conversation.

Of course, you will need a computer that could run the Shadow Health. I am a computer geek guy and have a computer with a high powered graphics card and I had no trouble running the program. Many of you will run the Shadow Health with a laptop. It will run but many of them will have their computer fan going crazy and your computer will get hot. I recommend you get a laptop fan while you are doing the Shadow Health on your laptop. It will save your laptop’s life. Now, you are ready to do the assignment.

When you talk to Tina, you may want to talk very clearly to the microphone as the program may pick up totally different words than what you said.

As you go through the Shadow Health, you will fill in the right side of the box with Subjective, Objective, Assessment, and Plan.

Subjective
This is where you are going to use SOAP note. Start with the chief complaint (CC), HPI, social hx, family hx, and ROS. As you go week by week, you will notice that you will see yourself repeating the same thing over and over again beside the CC. No, you cannot copy and paste. You would have to type all over again with the same family hx and social hx. This is where I felt a waste of time.

Objective
Most of the major points that you will be getting are from the Objective part. Be very specific about the Objective part. For example, when asked Tina “Do you have any pain?”, she may answer, “I have a stomachache.” Then, you would want to go every detail about a stomachache. Which part is hurting, since when did it get hurt, what made it hurt, what aggravates, and so on. Every single detail part you get in to and ask the right question, you get credit for it. Make sure that you also empathize Tina whenever she reports pain like “I am sorry to hear that.”

Assessment
Depending on your instructor, you will be required to come up with 3 or more differential diagnosis including ICD-10 code for each diagnosis.

Plan
This where you input any diagnostics, medication, education, referral/consultation, and follow-up planning.

Once you complete the exam, you think you will go to the score page. Haha! You wish! Now, here comes a few T/F, multiple-choice questions, and short discussions. Then in the end, you will write self-reflection. Bah… -_-

Now, you will get to the score. If I remember correctly, your DCE (Digital Clinical Experience) score has to be greater than 93% for you to pass the assignment. % score is not equal to your grade score. If you got lower than the cutline score, then you can repeat the ENTIRE process again 2 more times. haha… Trust me, you don’t want to do more than once on each Shadow Health assignment. Get it done right on the first trial, get over with it. But the good (?) part is that you get to see what you missed and you can literally do it over again by looking at it.

Be warned! So, some people use “trick” for this. Because you get to see the entire “answers” after the first trial, some people would start and end the 1st trial right away. It will result in 0% DCE score and a very short time you spent will be recorded. Then they use that “answer” to do the 2nd trial. This considered academic dishonesty. So, be aware. The time you spent on it is also recorded.

Once you are done with the assignment, you will see this page.
On the upper right-hand corner, you see the “Lab Pass”.  Click on it and you will download a pdf file that looks like this.

This is the pdf file that you will turn in on each Physical Assessment Assignment.

Debriefing Session or Alternative Writing Assignment
Your instructor will hold a live conference over the phone and computer. I strongly suggest you attend it every week as you do not want to do much lengthy Alternative Writing Assignment. You get a basic attendance score but also how active you are with discussion. I know you would be eager to talk and participate but give others to speak also. It shouldn’t last longer than an hour.

Weekly Quiz
To me, it didn’t feel that hard at all. I did read the entire book (Jarvis – Physical Examination and Health Assessment) which helped. I read cover to cover and getting A from quizzes was easy.

APEA 3P Exam
This is something else. Let me tell you this. There is NO WAY you can prepare for this. If you are reading this post much earlier than NR509 class, then I guess you can prepare this exam by reviewing entire pharmacology, pathophysiology, and epidemiology. Again, there is no way you can prepare for it. So, just relax and let the exam begin. The black stuff is the letters and white around it is the background. Read through as if you are flipping through a magazine and get it over with. Score? It’s either you get full 85 points if you pass or 0 if you don’t pass. I believe the cut score is 75% (73%?). It’s the only exam that is not proctored.

Other supplement that may help
SOAP Note information

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Immersion weekend for NR509 – Chamberlain University

*Last updated 090419

I would like to share commonly asked questions about Immersion for students in the Chamberlain University FNP Program.

It’s 2 nights and 3 days program over the weekend from Friday to Sunday (some cohorts may go from Thursday to Saturday) on the 7th weekend of NR509. Sometimes on a different weekend if the weekend overlaps with holidays. Check with your student advisor!

Here is the Fact Sheet for the Immersion. The Fact Sheet is the same as what I am about to present here. I just wrote with my personal touch to it. =]

Items you will need for the Immersion. (Immersion Student Equipment)

1. Print out of NR 509 Immersion Grading Rubric (for your practice)
2. Print out of ECG Immersion Station Student Handouts updated 3.1.19
3. Print out of Skin Rash Station Worksheet and Handout (make sure that the page with 8 skin pictures are in color)
4. Pocket Snellen chart ($3.00)
5. Taylor Hammer ($4.00)
6. Stethoscope ($4.95 to infinity) but you can take disposable one from your hospital.
7. Otoscope ($15 to infinity) this is totally up to you what you want to buy. (No, you don’t need ophthalmoscope. You can use otoscope light to test pupil constriction – CN2!!!)
8. A small notebook (Post-It was sufficient for me) and a pen
9. Whitecoat (I would say optional as you are not required to wear as long as you are not wearing a pair of jean. You should be wearing semi-casual.) I am a male, 5’7″ and 135 lb. I ordered size small and felt about right or slightly bigger.
10. Name tag that school makes you order. You will get an email regarding this from school. I didn’t feel like it was really needed as you will be receiving another name tag when you get there. But I heard some instructors did check when you take the Immersion exam.
11. Dress code: As long as you are not wearing jeans and T-shirts with open-toe shoes, you are fine. Semi-casual is what I wore and that was more than sufficient. For the day 3 exam, you need to wear something that you can show your tummy easily as you will need to expose your tummy for the assessment exam.
12. You must purchase the DayPass in order for you to enter Q-Center. Adding meal plans or not is up to your decision.

Some people buy a set of items in a bulk pack that has everything in it. So, it will be all depending on your preference. *Price may differ.

Where to stay?

You can stay at the Q Center. It will cost you about $400 for 2 nights including dinner on day 1, 3 meals on day 2, and breakfast on day 3. The $400 package also includes a ride from/to airport.

The Q Center standard room looks like this.

Doesn’t look too bad? Well, this is “very” well-taken picture with the stretched lens. I felt like the bed was smaller than a single bed size. I felt like it was a sofa seating size or slightly bigger. The room width is the size of a closet width. Don’t get disguised by their pictures. =p

This is the restroom and shower. The restroom felt like the size of a closet or a little bigger. More detailed pictures are here.

I have heard that some rooms didn’t have AC or AC didn’t work. You can also pay more to get a bigger room with a queen-size bed. I didn’t see it but you are only going to be sleeping there. I don’t think extra money to be in the bigger room matters.

I did Airbnb ($75 for 2 nights) and stayed about 20 minutes away from the Q Center. I rented a car for driving back and forth. I love exploring new areas and looking at houses. That’s why I decided not to stay in the Q Center. It ended up saving about $100 including food. (I am not a big eater at all.) This particular host had 2 rooms that he rents out. 1 room with a queen bed and the other room with a single bed. If 2 of you go there, half the price!

The Immersion event is in the Q Center of St. Charles, IL. (Click for google map) The Q Center is about 35 minutes to the east of O’Hare airport. The Q Center is quite of size “hotel” with event halls. It’s a maze to get around the Q Center. So, use their “Q Center” app on the phone. The app icon looks like below.

When you are at the Q Center, open the app and it will prompt you to turn on the Bluetooth. The app uses Bluetooth to navigate inside of the Q Center. They have gift shops, restaurants, and etc.

The Immersion Agenda

So, what happens during the event? You can download the Immersion Agenda.
For Friday – Sunday: Day 1 is Friday, day 2 is Saturday, day 3 is Sunday.
For Thursday – Saturday: Day 1 is Thursday, day 2 is Friday, day 3 is Saturday.

Day 1 – Trip day. Basically, you can arrive at the Q Center on any date prior to day 2 by 0800. I strongly suggest you get there on day 1 and meet with classmates to practice the head to toe assessment each other. It feels very different when you practice with your family members compared to some random strangers. Day 1 is just simply a free day. No specific Immersion activity.

Day 2 – You will be asked to gather at a hall at 0800 and you will see about 450 students. Professors come out to and welcome you and generally go over the Immersion event. Then in small groups, students will gather up in classrooms for the hands-on learning experience of several different stations. I really felt that I learned something from the classes for the first time during the entire CU classes! Lunch will be provided for all students. Their food is not bad actually. Classes are completed around 1630 and you will be hanging out with all the students at the Reception event. Some finger food and beverages are offered there. Yes, some alcohol too. Each person will be given a “drink” ticket. Then you are free. I ended up meeting with a few students and practiced head to toe.

Day 3 – Gathering is at 0745 at the hall where you met all 450 students on day 2 morning. You will be called out with your partner for the Head-to-toe Physical exam. I was the 1st one to be called out and I was done by 0900. My flight was not until 2230 later that day. Hearing from others, the exam ended around 1400. But do not buy a ticket too close to 1400 as you will not know when you will be called out for the exam until the morning of day 3. I have seen people changing their flights on day 3 morning.

Suggestions/tips

1. Start viewing the head-to-toe assessment early. You don’t need to watch the entire video. Just watch section by section and repeat while you are driving to/from work from the 1st day of the NR509. I did the same and I never really spent extra time to memorize it at home.
2. When the exam starts, your examiner will have a timer on a table. The examiner will tell you to push on the start button whenever you are ready to start. Before you start, I suggest you lay out the exam equipment (otoscope, stethoscope, Taylor Hammer, and Snellen chart) on the table. This way, you know what equipment you used or not and remind you to use each equipment. Some examiners would let you write a note once the timer start. Ask your examiner if you can write stuff on a paper once the timer starts. If the examiner is ok with your writing, then write what you usually miss. I wrote CN 1~12 and checked off one by one as I completed each. This would be another check-off system. Remember that you only need 104 out of 124 for you to pass. That’s 20 points and missing 10 sections. 10 sections are a lot you can miss.
3. Book tickets early for a cheaper flight. I flew LAX to ORD for $214 round trip! And I only paid $14 for it by using AAdvantage credit card. When you sign up, at least when I sighed up, you get $200 credit for purchases. I used Hopper app on the phone to track the lowest price. Once you are done with the trip, you can cancel the credit card to avoid the $99 annual fee. 1st year AAdvantage credit card membership is free. (I am going back to Chicago for 661 review class and I actually saw $144 round trip on April 2020 from LAX!!)
4. Most of all, just relax and practice. Worrying about the Immersion exam isn’t going to help with the study. We all did it. You can do it!!!
5. Expect flight delays! OMG. Flight delay in/out of Chicago was crazy! I had many classmates get stuck in the airport for over 12 hours due to delays by the weather condition.
6. What I would do differently? I would have gathered up a couple of people and rent an entire house from Airbnb near the Q Center and stay together. I could have practiced the head-to-toe among the roommates and have an amazing time. Of course, you can also do it in the Q Center too. You will see people gathering in small to large groups to practice all over the Q Center. Transportation in Chicago was not cheap via Uber, especially as single travelers. (*If you are staying in the Q Center, the transport to/from airport and Q Center is provided.) But, if you are in a group of 4 or so, Uber can be much cheaper as you will share the cost with among others. I would rent a decent size car and fit 4 or more and share the cost for Airbnb, food, and car rental. As you go through the Immersion, you will find your “favorite” people. Since you will be returning to the Q Center again for NR661, it would be a good idea to plan for a group Airbnb rental.
7. You rented a car? Rental companies will scare you with “toll road” and make you purchase the toll pass scanner for about $10/day + tax. The toll fee supposed to be about $2.5 or so on each pass and it can definitely add up. However, from ORD to the Q Center, it will take about 40 minutes or so without going through the toll roads. Just make sure that you place “off” on the toll roads on the google map or GPS, and go through local streets. You will find amazing Chicago pizza places! It will probably take 10~15 minutes more to get to the Q Center from the ORD. I wouldn’t mind driving that. So, don’t get the toll pass.
8. June 2019, the gas price at Costco was about $2.79/gal. The rental car companies will charge you $2.99/gal for not filling up.

Yes, please share this post with anyone. If you have any questions, do not hesitate to contact me. =]

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