Posted: September 2nd, 2022

“pain in the left great toe for 3 days”

Rubric Title: Unit 2, 4, 6 Lab – Virtual Reality Rubric

***Students: It is IMPORTANT to remember to utilize both the “Guided Mode” and “Expert Mode” in the VR Lab Simulation case scenario experiences, as you practice the VR Lab scenario(s). The “Guided Mode” and “Expert Mode” allow you to have multiple tries/attempts to practice the case. THEN, when you feel you are ready, you will choose the VR Lab “Exam Mode” (that you can ONLY attempt once); the score you receive in “Exam Mode” will then be your final grade in the VR Lab. If you have any questions regarding this, please follow up with your course instructor.

Assignment Criteria Level III Level II Level I Not Present
Criteria 1 Level III
Points: 80 Level II
Points: 64 Level I
Points: 48 Not Present
0 Points
Total Score

● Within Exam Mode, obtains 65 to 80 points of the required total components for virtual reality patient scenario
● Within Exam Mode, obtains between 49 to 64.9 points of the required total components for virtual reality patient scenario ● Within Exam Mode, obtains between 33 to 48.9 points of the required total components for virtual reality patient scenario ● Does not attempt in Exam Mode
● Does not meet the criteria

Rubric Title: Unit 3, 5, 7 SOAP Journal Assignment Rubric

Criteria 1 Level III Max Points
Points: 8 Level II Max Points
Points: 6.4 Level I Max Points
Points: 4.8 0 Points
Content Quality- Subjective Data
Subjective data displays complete understanding of all critical concepts of virtual reality patient case including:
● Name, age, gender
● Chief complaint
● History of present illness (HPI) that follows OLD CARTS pneumonic
● Medications
● Allergies
● Past medical history
● Past surgical history
● Pertinent family history
● Social history
● Review of Systems ● Subjective data displays understanding of critical concepts of chosen virtual reality patient case; there may be 1-2 critical concepts with errors/omissions or lack of details. ● Subjective data displays understanding of critical concepts of chosen virtual reality patient case; there may be 3-4 critical concepts with errors/omissions or lack of details. ● Does not meet criteria
Criteria 2
Level III Max Points
Points: 8 Level II Max Points
Points: 6.4 Level I Max Points
Points: 4.8 Not Present
0 Points
Content Quality- Objective Data
Objective data displays complete understanding of all critical concepts of chosen virtual reality patient case including:
● Vital signs
● Body systems that are pertinent to specific case ● Objective data displays understanding of critical concepts of chosen virtual reality patient case; there may be 1-2 critical concepts with errors/omissions or lack of details. ● Objective data displays understanding of critical concepts of chosen virtual reality patient case; there may be 3-4 critical concepts with errors/omissions or lack of details ● Does not meet criteria
Criteria 3 Level III Max Points
Points: 4 Level II Max Points
Points: 3.2 Level I Max Points
Points: 2.4 Not Present
0 Points
Content Quality- Assessment Assessment displays complete understanding of all critical concepts of chosen virtual reality patient case including:

● Primary diagnosis
● Pathophysiology of primary diagnosis
● Three differential diagnoses
● Rationales for differential diagnoses ● Assessment displays understanding of critical concepts of chosen virtual reality patient case; there may be 1 critical concept with errors/omissions or lack of details. ● Assessment displays understanding of critical concepts of chosen virtual reality patient case; there may be 2 critical concepts with errors/omissions or lack of details. ● Does not meet criteria
Criteria 4 Level III Max Points
Points: 4 Level II Max Points
Points: 3.2 Level I Max Points
Points: 2.4 Not Present
0 Points
Content Quality- Plan of Care
Plan displays complete understanding of all critical concepts of chosen virtual reality patient case including:

● Medications
● Non-pharmacological recommendations
● Diagnostic tests
● Patient education
● Cultural considerations
● Health promotion
● Referrals
● Follow-Up ● Plan displays understanding of critical concepts of chosen virtual reality patient case; there may be 1 critical concept with errors/omissions or lack of details. ● Plan displays understanding of critical concepts of chosen virtual reality patient case; there may be 3-4 critical concepts with errors/omissions or lack of details. ● Does not meet criteria
Criteria 5 Level III Max Points
Points: 3 Level II Max Points
Points: 2.4 Level I Max Points
Points: 1.8 Not Present
0 Points
Collegiate-level academic writing

● Includes no more than three grammatical, spelling, or punctuation errors that do not interfere with the readability.
● Supports all opinions and ideas with relevant and credible reference sources of information.
● Provides three or more peer-reviewed or evidence-based practice scholarly references sources.
● All reference sources are within the past five years.

● Includes no more than four grammatical, spelling, or punctuation errors that do not interfere with the readability.
● Supports many opinions and ideas with relevant and credible sources of information.
● Provides two peer-reviewed or evidence-based practice scholarly references sources.
● All reference sources are within the past five years. ● Includes five or more grammatical, spelling, and punctuation errors that makes understanding parts of assignment difficult, but does not interfere with readability.
● Not all references utilized are relevant and/or credible sources of information.
● Provides one peer-reviewed or evidence-based practice scholarly references source.
● Reference sources are within the past five years. ● Does not meet criteria
Criteria 6
Level III Max Points
Points: 3 Level II Max Points
Points: 2.4 Level I Max Points
Points: 1.8 0 Points
Citations and Formatting
● The overall order of information is clear and contributes to the meaning of the assignment. There may be 1-2 sentences, or one paragraph that is out of order, or other minor organization issues.
● Correctly citing all reference sources. One or two formatting, in-text, or reference citation errors may occur.
● Quotation marks and citations make authorship clear. ● The overall order of information is confusing in places due to 3-4 sentences, or two paragraphs that may be out of order, or other organization issues that interfere with the meaning or intent of the paper.
● Correctly citing all reference sources. 3-4 formatting, in-text, or reference citation errors may occur.
● Quotation marks and citations generally, make authorship clear. ● The overall order of information is confusing in places due to 5-6 sentences or three paragraphs that may be out of place, or other organization issues that interfere with the meaning or intent of the paper.
● Attempts to cite. 5-6 formatting, in-text, or reference citation errors may occur.
● Quotation marks and citations may be missing or incorrect.
● Authorship may be unclear in areas. ● Does not meet criteria
Maximum Total Points 30 24 18
Minimum Total Points 25 19

Rubric Title: Unit 8 Journal Rubric

Criteria 1 Level III Max Points
Points: 15 Level II Max Points
Points: 12 Level I Max Points
Points:9 0 Points
Content Quality- Subjective Data
Presentation of subjective data displays complete understanding of all critical concepts of chosen virtual reality patient case including:
● Name, age, gender
● Chief complaint
● History of present illness (HPI) that follows OLD CARTS pneumonic
● Medications
● Allergies
● Past medical history
● Past surgical history
● Pertinent family history
● Social history
● Review of Systems ● Presentation of subjective data displays understanding of all critical concepts of chosen virtual reality patient case; there may be 1-2 critical concepts with errors/omissions or lack of details. ● Presentation of subjective data displays understanding of all critical concepts of chosen virtual reality patient case; there may be 3-4 critical concepts with errors/omissions or lack of details. ● Does not meet the criteria
Criteria 2
Level III Max Points
Points: 15 Level II Max Points
Points: 12 Level I Max Points
Points:9 0 Points
Content Quality- Objective Data
Presentation of objective data displays complete understanding of all critical concepts of chosen virtual reality patient case including:
● Vital signs
● Body systems that are pertinent to specific case ● Presentation of objective data displays understanding of all critical concepts of chosen virtual reality patient case; there may be 1-2 critical concepts with errors/omissions or lack of details. ● Presentation of objective data displays understanding of all critical concepts of chosen virtual reality patient case; there may be 3-4 critical concepts with errors/omissions or lack of details. ● Does not meet the criteria
Criteria 3 Level III Max Points
Points: 15 Level II Max Points
Points: 12 Level I Max Points
Points:9 0 Points
Content Quality- Assessment Presentation of assessment displays complete understanding of all critical concepts of chosen virtual reality patient case including:

● Primary diagnosis
● Pathophysiology of primary diagnosis
● Three differential diagnoses
● Rationales for differential diagnoses ● Presentation of assessment displays understanding of all critical concepts of chosen virtual reality patient case; there may be one critical concept with errors/omissions or lack of details. ● Presentation of assessment displays understanding of all critical concepts of chosen virtual reality patient case; there may be two critical concepts with errors/omissions or lack of details. ● Does not meet the criteria
Criteria 4 Level III Max Points
Points: 15 Level II Max Points
Points: 12 Level I Max Points
Points:9 0 Points
Content Quality- Plan of Care
Presentation of plan displays complete understanding of all critical concepts of chosen virtual reality patient case including:
● Medications
● Non-pharmacological management
● Diagnostic tests
● Patient education
● Cultural considerations
● Health promotion
● Referrals
● Follow-Up ● Presentation of plan displays understanding of all critical concepts of chosen virtual reality patient case; there may be one critical concept with errors/omissions or lack of details. ● Presentation of plan displays understanding of all critical concepts of chosen virtual reality patient case; there may be 3-4 critical concepts with errors/omissions or lack of details.s ● Does not meet the criteria
Criteria 5 Level III Max Points
Points: 15 Level II Max Points
Points: 12 Level I Max Points
Points:9 0 Points
Quality of Oral Presentation ● Presentation demonstrated thorough organization and delivery.
● All ideas were stated in a clear and logical manner.
● Presentation was on topic and relevant.
● Presentation time no longer than 5 minutes ● Presentation was organized and well spoken.
● All ideas were stated in a clear and logical manner.
● Presentation was on topic and relevant.
● Presentation >5 minutes ● Presentation needed more details or content inconclusive.
● Presentation >5 minutes ● Does not meet the criteria
Maximum Total Points 75 60 45 0
Minimum Total Points 61 46 1

Name: James Hanson Pt. Encounter Number:
Date: 8/29/2022 Age: 47 Sex: M
SUBJECTIVE
CC:
“pain in the left great toe for 3 days”

HPI:
47 yo male presents to the office c/o pain in the left great toe with associated redness and swelling. He reports that the pain started 3 days ago when it woke him from sleep during the night. He reports he had “a few too many beers with the boys” prior to the onset of the pain. Pain is located in the left great toe joint and has been constant. He describes the pain as severe, throbbing, and pulsating. He reports that the bed sheet, socks or shoes make it worse and he is unable to stand, bear weight or wear a shoe.. Position changes, elevation, rest and aspirin have been ineffective. He did get minimal relief from ice to the area. Rates the pain a 10 on a 1-10 pain scale. Denies trauma to area. He reports he has had some periodic pain mild pain in the joint previously but he has not received care for this condition previously.

Medications: HCTZ 25mg daily for HTN x 10 years

Allergies: NKDA

Medication Intolerances: N/A
Past Medical History: HTN, overweight

Chronic Illnesses/Major traumas: History of clavicle fracture after a fall while intoxicated

Hospitalizations/Surgeries: denies

Preventive/Immunizations: Pt reports he is UTD on all immunizations. TDaP 2018, Flu 2019, Covid # 4/2021, Covid #2 4/2021. Screened and negative for all STD and HIV 3 months ago.

Family History
Both mother and father have history of HTN. Father treated for gouty arthritis in multiple joints. Maternal and paternal grandparents with history of CVD and diabetes.
Social History
Preferred pPt is employed as a lawyer, attended law school in Boston. Never married, lives alone and has no children. Sexually active, interested in women. Lifetime partners 20. Reports condom use 100% of the time. Denies tobacco use. Reports he drinks aprox 7-10 drinks a week, sometimes more. Uses marijuana on the weekends. CAGE score=0.

ROS
General
Denies recent change in weight but reports needing to lose some weight. Denies fever, chills, night sweats, fatigue. Cardiovascular
Denies chest pain, palpitations, dizziness, syncope.

Skin
Denies rashes or bruising. Reports redness and swelling of left great toe with peeling skin.
Respiratory
Denies cough, SOB

Eyes
Denies any problems with eyes, no change in vision.
Gastrointestinal
Denies abdominal pain, nausea, vomiting, constipation.

Ears
Denies ear pain or difficulty hearing.
Genitourinary/Gynecological
Denies dysuria and frequency.

Reports he is sexually active, women only. Uses condoms 100% of the time. Screened for HIV and STD’s 3 months ago, all negative.

Head/Nose/Mouth/Throat
Denies trauma to head. Denies congestion, sore throat.
Musculoskeletal
Denies muscle or joint pain with the exception of the left great toe redness, swelling and pain. ROM intact all joints with the exception of left great toe which is limited due to pain. Denies trauma to area. Denies difficulty ambulating.
Breast
N/A Neurological
Denies syncope, dizziness. Denies numbness or tingling. Denies difficulty with speech, coordination or sensation.
Heme/Lymph/Endo
Denies swollen glands or lymph nodes. Denies bruising or bleeding. Denies being immunocompromised. Psychiatric
Denies depression/SI. Reports some trouble sleeping especially when using alcohol.
OBJECTIVE
Weight 200lbs BMI 28.7 Temp 98.5 BP 129/84 left, 128/82 right
Height 5’10” Pulse 86 Resp 18 O2 sat 99%
General Appearance
Healthy appearing, appropriately dressed, adult male. Alert and oriented; answers questions appropriately.
Skin
Redness and desquamation around left first metatarsophalangeal joint.
HEENT
Head is normocephalic, atraumatic, and without tenderness, visible or palpable masses, depressions or scarring. Hair evenly distributed. Eyes: PERRLA. Visual acuity intact. EOMs intact. Ears: Canals patent. Bilateral TMs pearly gray with positive light reflex; landmarks easily visualized. Nose: Nasal mucosa pink; normal turbinates. No septal deviation. Neck: Supple. No mass, trachea midline. Full ROM; no cervical lymphadenopathy; no occipital nodes. No thyromegaly or nodules. Oral mucosa, pink and moist. Pharynx is nonerythematous and without exudate. Teeth are in good repair.
Cardiovascular
Chest normal in appearance, no lifts, heaves, or thrills. S1, S2 with regular rate and rhythm. No extra sounds, clicks, rubs, or murmurs. Capillary refills two seconds. Pedal pulses 3+ bilaterally. No edema.
Respiratory
Symmetric chest wall. Respirations regular and easy; lungs clear to auscultation bilaterally.
Gastrointestinal
BS active in all the four quadrants. Abdomen soft, nontender. No hepatosplenomegaly.
Breast
Deferred
Genitourinary
Deferred.
Musculoskeletal
Limping on left foot noted on ambulation, otherwise full ROM seen in all four extremities.
Neurological
Alert and oriented x4, speech clear. No motor deficit noted. Muscles strength 5/5 bilaterally. Sensantion intact bilaterally. Balance stable.
Psychiatric
Pt does not appear depressed or anxious. Maintains eye contact.
Lab Tests
6 Panel Drug Screen-
• Amphetamines-negative
• Barbituates-negative
• Cocaine metabolites-negative
• THC-negative
• Opiates-negative
• PCP-negative
Ethanol, blood- <5mg.dL
CBC
• RBC 4
• HGB 12
• HCT 36
• WBC 7
• Plt 157
CMP
• Glucose 99mg/dL
• Calcium 9.8mg/dL
• Sodium 138 mEq/L
• Chloride 100mEq/L
• BUN 19mg/dL
• Creatinine 0.9mg/dL
• Albumin 4.5g/dL
• Total Protein 7.5g/dL
• Alk Phos 40 U/L
• ALT 20 U/L
• AST 15 U/L
• Bilirubin 0.5mg/dL
ESR-5mm/hr
CRP-0.5
ANA < or = 1:4
RF Negative
Serum Uric Acid 8.4mg/dL
Synovial Fluid Analysis- positive for uric acid crystals but negative gram stain

Imaging
Left Foot Xray Normal, no radiologic evidence of fracture or bony lesions.
Assessment
o Include at least three differential diagnoses
▪ Provide rationale for each differential diagnosis
o Final diagnosis
▪ Pathophysiology of primary and rationale for choosing as final
Plan
o Medications
o Non-pharmacological recommendations
o Diagnostic tests
o Patient education
o Culture considerations
o Health promotion
o Referrals
o Follow up

Unit 1 Reading:
Textbook Reading
Primary Care: The art and Science of Advanced Practice Nursing

● Chapter 2: Caring and the Advanced Practice Nurse
● Chapter 3: Health Promotion
● Chapter 4: The Art of Diagnosis and Treatment
● Chapter 5: Evidence Based Practice

Resources
PowerPoint Links:
● Diagnostic Reasoning

● American Cancer Society. (2021). Cancer Screening Guidelines. https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines.html

● Centers for Disease Control. (2021). Immunization schedules. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

● Center for Disease Control. (2021) Recommended Adult Immunization Schedules https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf

● U.S. Preventive Services Task Force. (2021). USPSTF A and B screening recommendations. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations

● Department of Health and Human Services, Office of Disease Prevention and Health Promotion (ODPHP). (2021). Healthy People 2030 https://health.gov/healthypeople

● U.S. Preventive Services Task Force. (2021). USPSTF all screening recommendations. https://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse-recommendations

Unit 2 Reading:
Textbook Reading
Primary Care: The art and Science of Advanced Practice Nursing
● Chapter 34: Cardiovascular Problems
● Chapter 35: Cardiac and Associated Risk Disorders
● Chapter 36 Dysrhythmias and Valvular Disorders
● Chapter 37: Disorders of the Vascular System

Resources
• https://www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.120.15026

• Department of Health and Human Services, Office of Disease Prevention and Health Promotion (ODPHP). (2021). Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/heart-disease-and-stroke
• The JNC 8 Hypertension Guidelines: An In-Depth Guide ( 2014),
o https://www.ajmc.com/view/the-jnc-8-hypertension-guidelines-an-in-depth-guide

Unit 2 Assignment:
VR Angela Atwater Hypertension Stage 2, and overweight
Unit 3 Reading:
Textbook Reading
Primary Care: The art and Science of Advanced Practice Nursing
● Chapter 28: Common Respiratory Complaints
● Chapter 29 Sleep Apnea
● Chapter 30: Infectious Respiratory Disorders
● Chapter 31: Inflammatory Respiratory Disorders
● Chapter 32: Lung Cancer
● Chapter 33: Smoking Cessation
Resources
● _sites_default_files_publications_AsthmaManagementGuidelinesReport-2-4-21.pdf
● Center for Disease Control and Prevention, (2021) Asthma Action Plans https://www.cdc.gov/asthma/actionplan.html
● Soap Note Template SOAP NOTE TEMPLATE (3).docx

Unit 4 Reading:
Textbook Reading
Primary Care: The art and Science of Advanced Practice Nursing
● Chapter 56: Common Endocrine and Metabolic Complaints
● Chapter 57: Glandular Disorders
● Chapter 58: Diabetes Mellitus
● Chapter 59: Metabolic Disorders

Resources
American Diabetes Association. (2021) Practice Guideline Resources.
https://professional.diabetes.org/content-page/practice-guidelines-resources

Center For Disease Control, (2021). Gout.https://www.cdc.gov/arthritis/basics/gout.html

Egan,B.,(2021),Treatment of Hypertension in Black Individuals. UpToDate.
https://www.uptodate.com/contents/treatment-of-hypertension-in-black-individuals
Fitzgerald,J.d, etal.American College of Rheumatology Guidelines; 2020 American College of Rheumatology Guideline for the Management of Gout Arthritis Care & Research Vol. 0, No. 0, June 2020, pp 1–17 DOI 10.1002/acr.24180 © 2020. https://www.rheumatology.org/Portals/0/Files/Gout-Guideline-Early-View-2020.pdf

Mayo Clinic, (2021) Gout. https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897

Unit 4 Assignment:

For this Activity, go to VR /James Hanson/Gout

Unit 5 Reading:
Textbook Reading
Primary Care: The art and Science of Advanced Practice Nursing
● Chapter 6: Common Neurological Complaints
● Chapter 7: Seizure Disorders
● Chapter 8: Degenerative Disorders
● Chapter 9 Stroke
● Chapter 10: Infectious and Inflammatory Neurological Disorders

Resources
● Soap Note Template SOAP NOTE TEMPLATE (3).docx

Unit 6 Reading:
Textbook Reading
Primary Care: The art and Science of Advanced Practice Nursing
● Chapter 52: Common Musculoskeletal Complaints
● Chapter 53: Spinal Disorders
● Chapter 54: Soft Tissue Disorders
● Chapter 55.: Osteoarthritis and Musculoskeletal Problems

Unit 7 Reading:
Textbook Reading
Primary Care: The art and Science of Advanced Practice Nursing
● Chapter 43: Common Urinary Complaints
● Chapter 44: Urinary Tract Disorders
● Chapter 45: Kidney and Bladder Disorders
Resource
Center For Disease Control and Prevention (CDC),2021 Acute Low Back Pain
https://www.cdc.gov/acute-pain/low-back-pain/index.html

SOAP Note Template SOAP NOTE TEMPLATE (3).docx

Unit 8 Reading:
Textbook Reading
Primary Care: The art and Science of Advanced Practice Nursing
● Chapter 18: Common Eye Complaints
● Chapter 19: Lid and Conjunctival Pathology
● Chapter 20: Visual Disturbances and Impaired Vision
● Chapter 21: Common Ear, Nose and Throat Complaints
● Chapter 22: Hearing and Balance Disorders
● Chapter 23: Inflammatory and Infectious Disorders of the Ear
● Chapter 24: Inflammatory and Infectious Disorders of the Nose, Sinuses and Throat
● Chapter 25: Epistaxis

Unit 9 Reading:
Textbook Reading
Primary Care: The art and Science of Advanced Practice Nursing
● Chapter 79: Ethical and Legal Issues of a Caring Based Practice
● Chapter 38: Common Abdominal Complaints
● Chapter 39: Infectious Gastrointestinal Disorders
● Chapter 40: Gastric Disorders
● Chapter 41: Gall Bladder and Pancreatic Disorders
● Chapter 42: Cirrhosis and Liver Failure

Unit 10 Reading:
Textbook Reading
Primary Care: The art and Science of Advanced Practice Nursing
● Chapter 64: Common Psychosocial Complaints
● Chapter 65: Substance Use Disorder
● Chapter 66: Schizophrenic Spectrum Disorders
● Chapter 67: Mood Disorders
● Chapter 68: Anxiety, Stress and Trauma-Related Disorders
● Chapter 69: Obsessive Compulsive Disorders
● Chapter 70: Behavioral Disorders
● Chapter 71: Neurodevelopmental Disorders

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