Discussion: Assessing Musculoskeletal Pain

Discussion: Assessing Musculoskeletal Pain

Case # 2 Ankle Pain:

A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?

Assignment:

Write an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Wk 8-Discussion Review of Case Study 1

Patient Information: A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

S.

CC  Back pain

HPI: SK is a 42-year-old Caucasian male that presents with constant lower back pain for the past two months. Reports that he is experiencing intermittent radiating pain to his left leg. The leg pain reportedly episodic, and lasts for multiple hours. The pain has caused SK to have mobility issues while completing ADL’s, as well as when he is at work. Pt expresses “The pain is achy and throbs in my back. When my leg is affected it feels like a burning pain”. Pain level is 6/10. Reports that lifting heavy objects aggravates the pain. Rest alleviates the pain. Pt has been using ice on lower back to treat the pain, as well as taking Ibuprofen 800 mg PO BID for the past two weeks. Denies any other associated symptoms with back pain.

Current Medications:

Ibuprofen mg PO BID for back pain

Atorvastatin 20mg PO once daily for HLD

 

Allergies: NKDA, No allergies to food or latex, No environmental allergies.

PMHx: HLD dx in 2016, prescribed Atorvastatin 20 mg PO once daily. All immunizations up to date. Flu shot received within one year of visit. No Surgical history reported. No previous hospitalizations. Last annual physical was in May of this year.

Soc Hx: SK is a construction worker that remains fairly active. Has been married for 3 years to wife, currently sexually active. Pt describes self as a “social drinker” and cannot recall last episode of alcohol consumption. Denies smoking or the use of any tobacco product. Denies illicit drug use. Exercises daily. Diet changes frequently and does not monitor intake. Wears seatbelt regularly driving company car and car for leisure purposes. Smoke detectors in home. Reports that his neighborhood is safe.

Fam Hx:

Father: Alive, age 67, Hx HTN

Mother: Alive, age 69, Hx HTN, HLD, Mitral Valve Prolapse

Maternal Grandmother: Alive, age 87, Hx HTN, HLD

Maternal Grandfather: Deceased at age 89; GI Bleed.

Paternal Grandmother: Deceased at age 61; Melanoma

Paternal Grandfather: Deceased at age 48; Lung CA

ROS:

GENERAL:  Denies fever, fatigue, sob, or recent illness.

SKIN:  Denies pruritus, rash, or areas of hyperpigmentation.

CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema. HX of HLD

RESPIRATORY:  No sob, dyspnea, cough, or hemoptysis.

MUSCULOSKELETAL:  Pain in lumbar region of back. Episodic pain that radiates from back down left leg impairing gait. Range of motion impaired.

O.

VS: BP: 145/90, RR: 16, HR: 84, T: 98.0 F, O2: 97% on RA; Ht. 5’10” wt. 220 lbs BMI: 31.75

GENERAL: Pt is calm and cooperative while sitting upright on the examination table. Pt appears to be in NAD at this time. Appears to have good hygiene maintenance. Answers all questions without contradiction. Speech is clear and coherent.

SKIN: No breakdown, lesions, abrasions, or rashes noted. No tenting.

CARDIOVASCULAR:  S1, S2 heard with no murmur. S3 audible in mitral landmark. No edema noted in upper and lower extremities.

RESPIRATORY: Respirations even and unlabored. Equal chest rise and fall. Lung sounds clear throughout anterior and posterior landmarks.

MUSCULOSKELETAL:  Pain in lumbar region of back. No deformity noted throughout lumbar region. Episodic pain that radiates from back down to left leg impairing gait. Range of motion impaired when attempting hyperextension of spine.

 

Diagnostic results: X Ray of Lumbar Spine, CT cervical and lumbar spine. MRI lumbar spine.

A diagnostic test, such plain radiographs, standing anteroposterior and lateral views of the spine, bone scan, electromyography, as well as CT scan or an MRI scan, may be recommended in order to confirm the presence of the suspected cause of the patient’s pain (Dains, Baumann, & Scheibel, 2016).

A.

1.Sciatica- Disc herniation causes nerve root irritation and produces acute lower back pain that radiates down the buttock to the below the knee. Acute lower back pain is associated with pain and burning that radiates to along the lateral thigh, leg and foot, sometimes associated with numbness alone the dermatomal areas. Pain that is sharp and burning and radiates down the lateral and posterior aspect of the leg to the lateral ankle or foot is called sciatica and is a classical symptom of nerve root irritation most often caused by disk displacement (Dains, Baumann, & Scheibel, 2016). During the physical exam, I will check the patient’s muscle strength and reflexes. For example, will ask the patient to walk on the toes or heels, rise from a squatting position and, while lying supine, and lifting the legs one at a time. Pain that results from sciatica will usually worsen during these activities. Sciatica is the primary diagnosis, based on the clinical symptoms, results of physical examinations and diagnostics.

2. Herniated lumbar disc-A herniated disk refers to a problem with one of the disks between the vertebrae that stack up to make the spine (Lama et al., 2014). A herniated disk can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg (Lama et al., 2014). Diagnosis usually includes: CT lumbar spine, X-ray and an MRI.

3. Muscle strain- Muscle strain is damage to a muscle or its attaching tendons (Benjamin, 2014). This can occur when putting extreme pressure on muscles during the course of normal daily activities, with sudden heavy lifting, during sports, or while performing work tasks (Benjamin, 2012). A physical exam is done, and possibly an X-ray to rule out other diagnosis. Resting, with the use of NSAIDs is the most common course of treatment (Benjamin, 2014).

4. Lumbar Stenosis- Stenosis means the abnormal narrowing of a body channel when combined with the word spinal, it defines a narrowing of the bone channel occupied by the spinal nerves or the spinal cord, lumbar stenosis affects the lower back and cervical stenosis is in the neck. Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. Spinal stenosis is the most common cause of acute lower back pain in adults older than 50 years,   the cause of spinal stenosis in the lumbar spine is commonly associated with aging (Ullrich, 2017). The facet joints (small stabilizing joints located between and behind vertebrae) tend to get larger as they degenerate and can compress the spinal nerve roots in the lower back, often producing lumbar stenosis symptoms of pain, especially with activity (Ullrich, 2017). Pain is associated with lumbosacral radiculopathy, pain occurs with walking or standing, and relief with sitting or forward flexion of the spine most often in the lower back and the neck Dains, Baumann, & Scheibel, 2016) This condition is not a likely diagnosis based on the nature of the disease, including symptoms.

 

5. Ankylosing Spondylitis- This is a systemic inflammatory condition of the vertebral column and the sacroiliac joints. Ankylosing Spondylitis (AS) is a kind of arthritis that affects joints such as the hips, knees, and shoulders. According to Dains, Baumann, & Scheibel, 2016, AS can lead to weak, brittle bones (osteoporosis). The classic symptom is pain and stiffness in the hips and lowers back (Dains, Baumann, & Scheibel, 2016). This condition is usually reported as chronic lower back pain, which is worse on the morning rising and lessens as the day progresses. Physical examination reveals thoracic kyphosis and rounding of the posterior thoracic spine with forwarding flexion of the head, neck and the lower back (Dains, Baumann, & Scheibel, 2016). This condition is ruled out secondary to the inflammatory nature of the disease and the signs as symptoms as presented.

 

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier.

Benjamin, B. E. (2014). Interosseous Muscle Strains. Massage & Bodywork, 27(3), 108-111 4p. Retrieved from: http://web.b.ebscohost.com.ezp.waldenulibrary.org/ehost/detail/detail?vid=8&sid=170f1c32-41ce-459b-8d12-eca3f64ce3ab%40sessionmgr112&hid=125&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=108129119&db=rzh

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby. Care63(10), 1281–1292. https://doi-org.ezp.waldenulibrary.org/10.4187/respcare.05935

Lama, P., Zehra, U., Balkovec, C., Claireaux, H. A., Flower, L., Harding, I. J., &  Adams, M. A. (2014). Significance of cartilage endplate within herniated disc tissue. European Spine Journal: Official Publication Of The European Spine Society, The European Spinal Deformity Society, And The European Section Of The Cervical Spine Research Society, 23(9), 1869-1877. doi:10.1007/s00586-014-3399-3Philips, C. A. (2017). Diagnosing cirrhosis – comprehension in a nut shell. International Journal of Surgery and Medicine, Vol 3, Iss 2 (2017), (2). https://doi-org.ezp.waldenulibrary.org/10.5455/ijsm.cirrhosis-diagnose

Ullrich, P. F. (2017). Lumbar Spinal Stenosis: A Definitive Guide. Retrieved from https://www.spine-health.com/conditions/spinal-stenosis/lumbar-spinal-stenosis-a-definitive-guide

Week 8: Assessment of the Musculoskeletal System

A 46-year-old man walks into a doctor’s office complaining of tripping over doorways more frequently. He does not know why. What could be the causes of this condition?

Without the ability to use the complex structure and range of movement afforded by the musculoskeletal system, many of the physical activities individuals enjoy would be curtailed. Maintaining the health of the musculoskeletal system will ensure that patients live a life of full mobility. One of the most basic steps that can be taken to preserve the health of the musculoskeletal system is to perform an assessment.

This week, you will explore how to assess the musculoskeletal system.

Learning Objectives

Students will:

  • Evaluate abnormal musculoskeletal findings
  • Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the musculoskeletal system

Learning Resources

Required Readings (click to expand/reduce)

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

 

  • Chapter 4, “Vital Signs and Pain Assessment” (Previously read in Week 6)
  • Chapter 22, “Musculoskeletal System”This chapter describes the process of assessing the musculoskeletal system. In addition, the authors explore the anatomy and physiology of the musculoskeletal system.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

 

  • Chapter 2, “The Comprehensive History and Physical Exam” (“Muscle Strength Grading”) (Previously read in Weeks 1, 2, 3, 4, and 5)
  • Chapter 3, “SOAP Notes”This section explains the procedural knowledge needed to perform musculoskeletal procedures.

Note: Download this Student Checklist and Abdomen Key Points to use during your practice abdominal examination.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Musculoskeletal system: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Musculoskeletal system: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

This study examines the medical decision making among Hispanics and non-Hispanic whites. The authors also analyze the preferred information sources used for making decisions in these populations.

Document: Episodic/Focused SOAP Note Exemplar (Word document)

Document: Episodic/Focused SOAP Note Template (Word document)

Optional Resource

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

 

  • Chapter 13, “The Spine, Pelvis, and Extremities” (pp. 585–682)In this chapter, the authors explain the physiology of the spine, pelvis, and extremities. The chapter also describes how to examine the spine, pelvis, and extremities.
Required Media (click to expand/reduce)

Online media for Seidel’s Guide to Physical Examination

In addition to this week’s resources, it is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 21 that relate to the assessment of the musculoskeletal system. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/


Discussion: Assessing Musculoskeletal Pain

Photo Credit: Getty Images/Fotosearch RF

The body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provides the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.

In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

To prepare:

  • By Day 1 of this week, you will be assigned to one of the following specific case studies for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
  • Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
  • Review the following case studies:

Case 1: Back Pain

Photo Credit: University of Virginia. (n.d.). Lumbar Spine Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/5lumbar/01anatomy.html. Used with permission of University of Virginia.

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

Case 2: Ankle Pain

Photo Credit: University of Virginia. (n.d.). Lateral view of ankle showing Boehler’s angle [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/8ankle/01anatomy.html. Used with permission of University of Virginia.

A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?

Case 3: Knee Pain

Photo Credit: University of Virginia. (n.d.). Normal Knee Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/7knee/01anatomy.html. Used with permission of University of Virginia.

A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?

With regard to the case study you were assigned:

  • Review this week’s Learning Resources, and consider the insights they provide about the case study.
  • Consider what history would be necessary to collect from the patient in the case study you were assigned.
  • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
  • Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 8”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3 of Week 8

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Week 8

Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 8 Discussion Rubric

Post by Day 3 of Week 8 and Respond by Day 6 of Week 8

To Participate in this Discussion:

Week 8 Discussion


Assignment: Lab Assignment (Optional): Practice Assessment: Musculoskeletal Examination

A description of symptoms alone is not enough to form an accurate diagnosis of musculoskeletal conditions. Before forming a diagnosis, advanced practice nurses need to perform a physical examination. Although the musculoskeletal examination is relatively simple, it still needs to be performed multiple times before it can be mastered.

In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week 9, it is recommended that you practice performing a musculoskeletal examination this week.

Note: This is an optional practice physical assessment.  

To Prepare

  • Arrange an appropriate time and setting with your volunteer “patient” to perform a musculoskeletal examination.
  • Download and review the Musculoskeletal Checklist provided in this week’s Learning Resources as well as review the Seidel’s Guide to Physical Examination online media.

The Lab Assignment

  • Perform the musculoskeletal examination. Be sure to cover all of the areas listed in the checklist.

What’s Coming Up in Week 9?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will examine appropriate methods for assessing the cognition and the neurologic systems during your Discussion. You also will complete the last assessment, Comprehensive (Head-to-Toe) Physical Assessment. Once again, you will conduct this assessment in the Digital Clinical Experience using the simulation tool, Shadow Health. Make sure to plan your time accordingly.

Week 9 Required Media

Photo Credit: [fergregory]/[iStock / Getty Images Plus]/Getty Images

Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Discussion. There are several videos of various lengths. Please plan ahead to ensure you have time to view these media programs to complete your Discussion on time.

Next Week

Week 9

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6512_Week_8_Discussion_Rubric
Grid View
List View
Excellent Good Fair Poor
Main Posting
45 (45%) – 50 (50%)
“Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
“Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
“Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.
0 (0%) – 34 (34%)
“Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
10 (10%) – 10 (10%)
Posts main post by Day 3.
0 (0%) – 0 (0%)
N/A
0 (0%) – 0 (0%)
N/A
0 (0%) – 0 (0%)
Does not post main post by Day 3.
First Response
17 (17%) – 18 (18%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response
16 (16%) – 17 (17%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%)
N/A
0 (0%) – 0 (0%)
N/A
0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on three different days.
Total Points: 100
Name: NURS_6512_Week_8_Discussion_Rubric

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