Reference no: EM133645229
Assignment: Soap Note "ADULT" Wellness Check-up
See the College Handbook regarding Academic Misconduct Statement.
Must use the sample templates for your soap note. Keep this template for when you start clinicals.
The use of templates is ok with regards to Turn it in, but the Patient History, CC, HPI, Assessment, and Plan should be of your own work and individualized to your made-up patient.
This is a link that will guide you on how to create a SOAP note and
What to expect on a wellness visit
What to Expect in a Wellness Visit (YouTube Video)
Topics
A. SOAP note / Adult Wellness (Annual) Checkup
Reading/Watching Material
A. Sample Note
B. Watch YouTube Video
C. Jarvis, C. (2016). Physical examination & health assessment. Seventh edition. St. Louis, Mo.: Elsevier
CSLO's
A. Formulate accurate differential diagnoses to promote health, prevent disease, and manage acute and chronic illness in adult and geriatric population.
B. Employs screening and diagnostic strategies in the development of diagnosis.
C. Demonstrate effective communication skills by performing culturally sensitive health assessment interviews
D. Critically analyze data and evidence for improving health outcomes.
EPSLO's
A. Integrate nursing and related sciences into the delivery of care to clients in diverse healthcare settings
B. Create effective interdisciplinary organizational and systems leadership in the care of clients in diverse care settings
C. Apply practice guidelines to improve practice and health outcomes.
D. Relate information and communication technologies to document and improve practice health outcomes
E. Employ collaborative interprofessional strategies for improving client and population health outcomes.
F. Evaluate the effectiveness of clinical prevention interventions that affect individual and population based-health outcomes, perform risk assessments, add design plans or programs of care.
G. Relate knowledge of illness and disease management to providing evidence-based care to clients, communities, and vulnerable populations in an evolving healthcare delivery system.