NR569 Differential Diagnosis in Acute Care Midterm
Exam.
1. Comprehensi
ve Patient
Assessment 6. SNAPPS method
2. Focused
Patient
Assessment
3. Subjective
Infor- mation
4. Objective
Infor- mation
5. Components
of
Comprehensi
ve Adult
Health
History
, NR569 Differential Diagnosis in Acute Care Midterm
Exam.
-Appropriate for new thoroughly and carefully as possible.
patients in the oflce or
hospital. -The clinical record from the Chief Complaint (CC) through the Review of
-Provides fundamental Systems (ROS) is considered SUBJECTIVE information.
and personalized -Includes symptoms which are health concerns the patient tells the
knowledge about provider.
patient. -Includes feelings, perceptions, and concerns obtained from the clinical
-Strengthens the clinician- interview.
patient relationship. -Examples: complaints of sore throat, headache, or pain.
-Helps identify or rule out
physical causes related to -All physical examination, laboratory information and test data are
patient concerns. objective data.
-Provides a baseline for
future assessments.
-Creates a platform for -Initial information (Identifying patient information/source/reliability)
health promotion through -Chief Complaint(s)
education and counseling. -History of Present Illness
-Develops proficiency in -Past Medical History
the skills of physical
assessment. -Family History
-Personal/Social History
-Appropriate for -Review of Systems (ROS)
established patients,
especially during
routine or urgent care
visits.
-Addresses focused
concerns or symptoms.
-Assesses symptoms
restricted to a specific
body system.
-Applies examination
methods relevant to
assessing the concern
or problem as
, NR569 Differential Diagnosis in Acute Care Midterm
Exam.
-Summarize the history and findings.
-Narrow the ditterential diagnosis to two to three possibilities.
-Analyze the ditterential by comparing and contrasting the possibilities.
-Probe the preceptor by asking questions about alternative approaches
or uncer- tainties.
-Plan the management of the patient's health issues.
-Select an issue from the case for self-directed learning.
7. Creating a -The ditterential diagnosis process involves using clinical reasoning to
Differ- ential distinguish between two or more conditions that share similar signs
Diagnosis and symptoms. Based on the CC the NP gathers information through
*Hoofbeats = PMH (subjective data) and physical examination (objective data) to
Horses NOT establish a broad list of common & uncommon diagnosis. As the
Ze- bras* provider collects more data, competing hypotheses are either
confirmed, disproved, or their priority changes.
8. Steps for 1. Initially start with a broad list of diagnoses until further information
Creat- ing a or data is obtained.
Differential
Diagnosis 2. List your top diagnosis FIRST followed by other potential diagnoses for
a specific problem *but keep it problem oriented until you have an
actual diagnosis.*
3. Aggressively prioritize work up of the most likely and most
harmful (ie, life threatening) diagnoses under consideration.
4. Prioritize the work up of ACUTE and REVERSIBLE diseases
followed by CHRONIC and IRREVERSIBLE (eg, delirium r/t a medical
cause vs. chronic, progressive de- mentia).
5. As information or data that ettectively rules out a particular diagnosis
for a chief complaint becomes available, remove that diagnosis from
your list & focus your attention on remaining possibilities.
, NR569 Differential Diagnosis in Acute Care Midterm
Exam.
6. Once a diagnosis has been confirmed, the problem list should
be diagnosis-ori- ented rather than problem-oriented.
9. Pertinent Positive - Symptoms or signs that are present that you would expect to find if
a possible cause for for a patient's problem were true, which then
supports the diagnosis.
10. Pertinent Expected symptoms or signs that are not present, facts that you would
Nega- tive expect to find if a possible cause for a patient's problem were true,
which then weaken this diagnosis by their absence.
11. Principles of
1. Is the organization clear?
Good
-Make the headings clear.
Documen-
-Accent your organization with indentations and spacing.
tation
**Checklist to En- - Arrange the HPI in chronologic order, starting with the current
episode, the filling
sure a Quality in relevant background information.
Clinical Record.**
2. Does the included information contribute directly to the
Assessment?
- Spell out the supporting evidence, both positive and negative, or each
problem or diagnosis. Make sure there is suflcient detail to support your
ditterential diagnosis and plan.
3. Are pertinent negatives specifically described?
-Often portions of the history or examination suggest that an
abnormality might exist or develop in that area. For example, for the pt with
notable bruises, record the "pertinent negatives", such as the absence of
injury or violence, familial bleeding disorders, or medications/nutritional
deficits that might lead to bruising.
4. Are there overgeneralizations or omissions of important data?
Exam.
1. Comprehensi
ve Patient
Assessment 6. SNAPPS method
2. Focused
Patient
Assessment
3. Subjective
Infor- mation
4. Objective
Infor- mation
5. Components
of
Comprehensi
ve Adult
Health
History
, NR569 Differential Diagnosis in Acute Care Midterm
Exam.
-Appropriate for new thoroughly and carefully as possible.
patients in the oflce or
hospital. -The clinical record from the Chief Complaint (CC) through the Review of
-Provides fundamental Systems (ROS) is considered SUBJECTIVE information.
and personalized -Includes symptoms which are health concerns the patient tells the
knowledge about provider.
patient. -Includes feelings, perceptions, and concerns obtained from the clinical
-Strengthens the clinician- interview.
patient relationship. -Examples: complaints of sore throat, headache, or pain.
-Helps identify or rule out
physical causes related to -All physical examination, laboratory information and test data are
patient concerns. objective data.
-Provides a baseline for
future assessments.
-Creates a platform for -Initial information (Identifying patient information/source/reliability)
health promotion through -Chief Complaint(s)
education and counseling. -History of Present Illness
-Develops proficiency in -Past Medical History
the skills of physical
assessment. -Family History
-Personal/Social History
-Appropriate for -Review of Systems (ROS)
established patients,
especially during
routine or urgent care
visits.
-Addresses focused
concerns or symptoms.
-Assesses symptoms
restricted to a specific
body system.
-Applies examination
methods relevant to
assessing the concern
or problem as
, NR569 Differential Diagnosis in Acute Care Midterm
Exam.
-Summarize the history and findings.
-Narrow the ditterential diagnosis to two to three possibilities.
-Analyze the ditterential by comparing and contrasting the possibilities.
-Probe the preceptor by asking questions about alternative approaches
or uncer- tainties.
-Plan the management of the patient's health issues.
-Select an issue from the case for self-directed learning.
7. Creating a -The ditterential diagnosis process involves using clinical reasoning to
Differ- ential distinguish between two or more conditions that share similar signs
Diagnosis and symptoms. Based on the CC the NP gathers information through
*Hoofbeats = PMH (subjective data) and physical examination (objective data) to
Horses NOT establish a broad list of common & uncommon diagnosis. As the
Ze- bras* provider collects more data, competing hypotheses are either
confirmed, disproved, or their priority changes.
8. Steps for 1. Initially start with a broad list of diagnoses until further information
Creat- ing a or data is obtained.
Differential
Diagnosis 2. List your top diagnosis FIRST followed by other potential diagnoses for
a specific problem *but keep it problem oriented until you have an
actual diagnosis.*
3. Aggressively prioritize work up of the most likely and most
harmful (ie, life threatening) diagnoses under consideration.
4. Prioritize the work up of ACUTE and REVERSIBLE diseases
followed by CHRONIC and IRREVERSIBLE (eg, delirium r/t a medical
cause vs. chronic, progressive de- mentia).
5. As information or data that ettectively rules out a particular diagnosis
for a chief complaint becomes available, remove that diagnosis from
your list & focus your attention on remaining possibilities.
, NR569 Differential Diagnosis in Acute Care Midterm
Exam.
6. Once a diagnosis has been confirmed, the problem list should
be diagnosis-ori- ented rather than problem-oriented.
9. Pertinent Positive - Symptoms or signs that are present that you would expect to find if
a possible cause for for a patient's problem were true, which then
supports the diagnosis.
10. Pertinent Expected symptoms or signs that are not present, facts that you would
Nega- tive expect to find if a possible cause for a patient's problem were true,
which then weaken this diagnosis by their absence.
11. Principles of
1. Is the organization clear?
Good
-Make the headings clear.
Documen-
-Accent your organization with indentations and spacing.
tation
**Checklist to En- - Arrange the HPI in chronologic order, starting with the current
episode, the filling
sure a Quality in relevant background information.
Clinical Record.**
2. Does the included information contribute directly to the
Assessment?
- Spell out the supporting evidence, both positive and negative, or each
problem or diagnosis. Make sure there is suflcient detail to support your
ditterential diagnosis and plan.
3. Are pertinent negatives specifically described?
-Often portions of the history or examination suggest that an
abnormality might exist or develop in that area. For example, for the pt with
notable bruises, record the "pertinent negatives", such as the absence of
injury or violence, familial bleeding disorders, or medications/nutritional
deficits that might lead to bruising.
4. Are there overgeneralizations or omissions of important data?
