MSN 553 & 572 RUBRIC WEEK 7:
Select a patient. You may use a peer, friend, or family for this assignment.
Verbally consent the patient at the beginning of the video, asking their permission to record and upload video as “unlisted” for instructor viewing/grading
The assessment must be conducted in English
Ensure the microphone volume is adequate
Ensure that you and the patient are in the camera’s frame at all times. This may involve moving the camera as needed to ensure the instructor can view and grade the exam
There is no video editing permitted, and you may not stop and restart the filming, as doing so gives students the advantage of looking at notes and instructions. The exam is meant to be performed from beginning to end without pausing.
The patient must be at least 6 years old to ensure good cooperation, and if the patient is a minor, you must be their legal guardian or parent, or must have the legal guardian/parent on camera and verbally consent at the beginning
Time limit for exam is 45 min maximum.
For this week, please have your patient dressed in loose fitting shorts, tank top or gown, sports bra (or bare chest if male) to be able to see the knees/shoulders, ankles, elbows, etc. May do the hip exam over clothing.
Perform only the specific body system exam on the patient for the video.
Submit this a comprehensive write-up of all the findings from every step done for the exam and the video in the assignment tab.
Submit link to video via Youtube by Monday. Submit in electronic format, no video tapes or discs will be accepted. Ensure your link works and privacy settings are correct (unlisted vs private – instructor can’t see private).
Click here for a tutorial
Student appearance for videos should be consistent with clinical attire, which is outlined in the FNP clinical handbook. Students should dress as they would for working as a provider in a primary care clinic (not ER/scrubs). Business or business casual attire is expected along with the USU lab coat and ID badge. The student should consult the handbook for more details. Please note that if the student appears in very revealing or inappropriate clothing (some examples including shorts, short skirts, low-cut shirts, wearing lab-coat with no clothing beneath, etc.), the instructor reserves the right to refuse to view the video and the student will re-record with appropriate clothing. Use The old cart
Musculoskeletal Examination & write up
Superior
Full points awarded
1/1, 2/2, 3/3, 4/4, etc Competent
(¾ points awarded)
0.75/1, 1.5/2, 2.25/3, ¾, etc Below standard
Half points awarded
0.5/1, ½, 1.5/3 2/4, etc. Far below standard/Item not done
0 points awarded
Student performs the item smoothly, correctly, without notes and while verbalizing the component.
For example, while the student is auscultating, he/she verbalized the appropriate locations for auscultation, performs it, and verbalizes what she/he is listening for (“I am listening for any crackles, wheezing, rales, rhonchi, or friction rub, and I note only bronchovesicular or clear lung sounds” Student either verbalizes the item only (but correctly) or student performs the item correctly but does not verbalize the step, or may use notes to aid them in performance of item. Student performs some elements of the item correctly, or does not verbalize the item correctly, or relies or reads from notes while doing the exam. Student does not perform or verbalize the item, or performs it completely incorrectly or in an unsafe/unclean manner.
PHYSICAL EXAM
HANDS
Inspection
_____ 1 Swelling, deformity, redness, muscular atrophy, nodules, & joint symmetry
Palpation
_____ 1 Distal & proximal interphalangeal
_____ 1 Metacarpophalangeal
ROM
_____ 1 Ability to make fist (tests function)
_____ 1 Flex and extend fingers of both hands also abduct and adduct fingers both hands
WRISTS
Inspection
_____ 1 Swelling, deformity, redness, atrophy, nodules, & joint symmetry
Palpation
______1 Palpation of wrists including metacarpals and carpal bones of wrists
ROM
_____ 1 Flex wrist to 90 degrees downward & Extend wrist to 90 degrees upward
_____ 1 Ulnar & radial deviation wrist (aka abduction and adduction)
Specialty Tests
_____ 1 Tinel’s sign – Hyperextend the wrist and tap the median nerve with your middle finger or reflex hammer. A positive sign is pain or parenthesis radiating down the palm into the index, middle, and lateral half of ring finger
_____ 1 Phalen’s test – Flex the wrist to 90 degrees and maintain it for at least 40-60 seconds. A positive test would be pain or parenthesis in the median nerve distribution.
ELBOWS
Inspection
_____1 Redness, swelling, nodules, joint symmetry
Palpation (Note Swelling, nodules, or pain)
_____ 1 Extensor surface of ulna, olecranon process, press on the lateral and medial epicondyles looking for pain – indicate which area indicates golfer’s/baseball elbow vs tennis elbow.
ROM
_____ 1 extension & flexion
_____ 1 supinate and pronate each hand with arms extended
SHOULDERS
Inspection (bilaterally and posterior/anteriorly)
_____ 1 Swelling, deformity, redness, atrophy, nodules, joint symmetry
Palpation (Noting for Tenderness & Fluid)
_____ 1 Acromioclavicular joint, biceps groove, tubercle of humerus, coracoid process, subdeltoid bursa (verbalize correct areas of palpation)
ROM
_____1 Flex shoulder forward to 180 degrees
_____1 Extend shoulder backward to 60 degrees without scapular motion (arm straight behind)
_____ 1 With arms at sides, abduct arm to 90 degrees (abduction)
_____1 Adduct shoulder across midline to 90 degrees
_____1 Place hands behind small of back (internal rotation to 90 degrees)
_____1 Place hands behind neck with elbows out to side (external rotation to 90 degrees)
Specialty Tests
_____ 1 Perform at least one specialty test listed in your Bates’ textbook for the shoulder. Specify the name of test (i.e. painful arc test, Hawkin’s sign, Empty Can), perform it correctly, and identify what structure or defect it is testing for. Example: Empty can test for supraspinatus strength and possible rotator cuff tear.
HEAD AND NECK
Inspection
_____ 1 Deformities, abnormal posture
Palpation
_____ 1 Place first two fingers of each hand in front of tragus of ear and have patient open and close mouth (assessing TMJ tenderness)
_____ 1 Palpate sternoclavicular, cervical spine, paracervical muscles, trapezius muscles, rhomboids
ROM
_____ 1 Flexion – (Touch chin to chest), extension (put head back)
_____ 1 Rotation: (rotate neck) side to side.
_____ 1 Lateral movement: Touch ear to corresponding shoulder, each side
_____ 0.5 Instruct patient to open and close mouth; assess degree of maximal opening (patient should be able to place 3 of their own vertically-placed fingers in mouth)
_____ 0.5 Lateral Movement with mouth open (move jaw side/side)
Specialty Tests
_____ 1 Spurling’s test (Cervical Compression test) for cervical radicular pain or paresthesia. Avoid this test on elderly/frail individuals or patients with serious spine disease or injury.
FEET AND TOES
Inspection
_____ 1 Swelling, calluses, deformity, corns, nodules, plantar warts, bunions
_____ 1 Flat feet (ples planus) – verbalize or observe (best while standing)
Palpation
_____ 1 Interdigital Neuroma (Morton’s Neuroma) and plantar fasciitis
_____ 1 Distal & proximal interphalangeals & metatarsals
ROM
_____ 1 Flex (curl) toes & extend toes
_____ 1 Invert foot & evert foot
ANKLES
Inspection
_____ 1 Swelling, deformity, nodules, discoloration
Palpation of medial/lateral malleolus and Achilles (gastrocnemius)
_____ 1 Nodules, tenderness
ROM (examiner must test both active and passive here)
_____ 1 Dorsiflex + plantar flex the ankle, rotate ankle in circles
KNEES
Inspection
_____ 1 Swelling, nodules, redness, alignment – valgus or varus deformity
Palpation
_____ 1 Suprapatellar pouch, sides of patella, popliteal fossa for Baker’s cyst
ROM (passive and active)
_____ 1 Extend knee to 0o (leg straight out) & flex knee to at least 120o
Specialty Tests
______0.5 Valgus stress (With the knee slightly flexed to approx. 200 place outer hand on the lateral side of knee, grasp the medial foot or ankle with the opposite hand, and abduct the lower leg)
_____ 0.5 Varus stress (With the knee slightly flexed to approx. 20o, place the inner hand on the medial side of the knee, grasp the foot or ankle with the opposite hand, and adduct the lower leg)
_____ 1 Lachman’s test: Flex knee slightly to about 20o and one hand stabilizes the lower femur while the other holds the tibia above the tibial tuberosity and then pulls and pushes the tibia to assess laxity of anterior and posterior cruciate ligaments.
_____ 0.5 Drawer test: Patient is supine, knee is flexed about 90o, examiner sits on patient’s foot, grabs the upper leg and pulls it anteriorly and posteriorly to assess for laxity of the respective cruciate ligaments. When done properly Lachman’s test is more sensitive.
_____ 0.5 McMurry’s Test. Medially rotate the tibia and extend the knee- looking for laxity, pain or crepitus
HIPS
Inspection
_____ 1 Swelling, nodules, redness, alignment
Palpation
_____1 Anterior superior iliac spine (ASIS), greater trochanter, Posterior superior iliac spine, sacroiliac joint
ROM – must do active AND passive
_____1 Flex knee to 45 degrees, externally and internally rotate each leg then return to original position.
_____1 Active & passive flexion of hip
_____1 Active & passive extension of hip
_____1 Abduction of hip to 60 degrees bilateral
_____1 Adduction of hip to 30 degrees bilateral
Specialty Tests
_____ 1 Thomas test (to detect occult hip flexion contracture): Have patient flex right knee and pull firmly against abdomen. This flattens the normal lumbar lordosis
_____ 1 Patrick’s or FABER test (flexion, abduction, external rotation of the hip) to test for hip or sacroiliac joint disease. Place patient’s left foot on the right distal quadriceps just above the patella. Gently but firmly press the left knee to the exam table.
Note: Tenderness of posterior hip or back.
SPINE
Inspection – overall spine while patient standing
_____1 Cervical or lumbar lordosis or dorsal kyphosis (from side)
_____1 Shoulder height symmetry & iliac crest symmetry
_____1 Skin creases below buttocks – symmetrical (verbalize, do not video)
Inspection – dorsolumbar spine with forward bend (Patient bends slowly forward as far as possible with back to examiner)
_____1 Symmetry of movement as patient flexes and extends (is one shoulder elevated higher than the other? Is one hip higher?)
_____1 Smooth curve of spine (any lateral deviation/scoliosis?)
_____1 Range of motion (how far can patient bend); Normal is about 90 o
Palpation
_____1 Palpate spinous processes, intervertebral spaces
_____1 Percuss spine: Using ulnar surface of fist
Patient stands with back to examiner. Examiner seated and stabilizes patient’s pelvis with hands.
ROM – active
_____1 Bend to the right and then left (lateral bending, 35o)
_____1 Bend back towards examiner (extension, 35o)
_____1 Twist shoulders to right then left (rotation, 30o)
Specialty Tests
_____ 1 Straight leg raise
Professionalism
_____ 1 Appearance/Hygiene: Student was neatly dressed (business casual) or wore lab coat over street clothes with neat appearance.Student washed hands or verbalized doing so. Maintained clean technique.
_____ 2 Autonomy: Ability to perform exam independently (1=constantly referred to notes, 2 = referred to notes about ½ the time, 3 = rarely/occasionally looked at notes, 4 = did not utilize notes)
______ 1 Consent: Student verbally consented patient at the beginning of the video
______ 2 Communication: 1 = student did not verbalize steps of exam to patient or to camera, 2 = student sometimes verbalize steps of the exam to patient and professor 3 = student verbalized most steps of the exam to patient and professor, 4 = studently constantly verbalized steps of exam to patient/professor
______ 1 Flow/Positioning: Exam was smooth with few interruptions and minimized patient movements, patient was placed in the proper position for exam techniques
TOTAL EXAM = 75 points
DOCUMENTATION
Category Superior Competent Below standard Far Below standard
Format The chosen format was neat and easy to read. Headings were clear.
5 The format was mostly easy to read and understand
4 The format was inconsistent, headings and different areas were not delineated
3 Very poor format, note was confusing to read.
1
Spelling/grammar/Correct medical terminology Clean note with zero or one mistake. Student used proper medical terms or acceptable abbreviations throughout the note
10 Mostly clean note, but some terms were not correct or some abbreviations were not appropriate.
8 Several errors or misuse of terminology and abbreviations.
6 Many errors and terms that distracted from the note, making it difficult to read.
4
Content Complete summary of objective findings. All findings in the exam written in the note properly
10 Partial, but accurate summary of objective information.
8 Limited summary of objective findings, missing many pieces performed in the exam.
6 Minimal written objective findings. Missing more than 50% of findings during exam.
2
Documentation Total 25
Phys Exam Total 75
TOTAL POINTS 100
