Fall 2021

NURS 6110-001 Advanced Health Assessment and Clinical Reasoning: Clinical Application

All students are responsible for checking their UTHSCSA Livemail account regularly (i.e., daily or several times every week) to obtain Official University Communication regarding their courses, program and student status.

Students are expected to follow all policies related to COVID-19 found on the university webpage: https://wp.uthscsa.edu/coronavirus/.

NOTE: Our campus has enabled the CANVAS MOBILE LEARN application. CANVAS tools such as discussions, quizzes or videos May or May NOT function on all mobile devices. This is because mobile devices are available with rapidly changing and different configurations. Hence, students must not depend on only a mobile device to access course materials. Students must have access to a laptop or desktop device to access course materials and complete assignments.

This course is Web Enhanced with WebCT icon
Please be sure to check the Current Computer Requirements

Welcome to Advanced Health Assessment and Clinical Reasoning: Clinical Applications! We look forward to working with you this semester. 
Our first class will be January 11th, Tuesday, from 8 am - 12 pm in room 1.221 on the first floor in the main Nursing building. This course is taken in conjunction with NURS 6210. 

Please refer to the combined course calendar for specific details of the location of class each week as with NURS 6210 sometimes we will be at the HEB simulation center or in the CSI School of Nursing lab. 



Section 02: Nancy McGowan, PhD, RN, CEN 

Associate Professor / Clinical 

Office Phone: (210) 567-5310 

Office Room: 2.222 

Office Hours: by Appointment 


Section 03: Amanda Bridges, DNP, APRN, ACNP-BC 

Assistant Professor / Clinical 

Office Phone: 210-450-8026 

Office Hours: by appointment 


Section 04: Wen Pao, DNP, APRN, ACNP-BC 

Assistant Professor / Clinical 

Email: pao@uthscsa.edu  

Office Phone: 210-617-5256 

Office Hours: by appointment 


Section 05: Sarah Knoeckel, FNP, APRN, FNP-BC (Course coordinator) 

Assistant Professor / Clinical 

Office Phone: 210-450-8974 

Office Room: 2.512 

Office Hours: by appointment 


Section 06Paula Christianson-Silva, DNPAPRN, ANP, FNP-BC 

Assistant Professor / Clinical 

Office Phone:  210-567-5871 

Office Hours: by appointment 


Section 7: Ken Miller, PhD, MJ, APRN, CFNP, FAAN, FAANP 

Endowed Professorship 

Office Phone:  210-567-3822 

Office Room:  2.506 

Office Hours: by appointment 


Section 08: Andrew Saldiva, MSN, APRN, FNP-C 

Assistant Professor / Clinical 

Email:  saldiva@uthscsa.edu  

Office Phone: 210-567-5800 

Office Hours: by appointment 


Section 09: Heidi Miller, MSN, APRN, FNP-BC 

Assistant Professor / Clinical 

Office Phone: 210-567-5803 

Office Room: 2.320 

Office Hours: by appointment 


Students will apply advanced health assessment techniques in the performance of focused and comprehensive health assessments of clients across the lifespan. Clinical reasoning, analysis, and synthesis of history and physical assessment data and diagnostic reasoning skills are developed.


Credit Hour Allocation:  1 semester credit hours
Clock Hour Allocation:   60 clock hours lab


NURS 6338 Advanced Pathophysiology

NURS 6210 Advanced Health Assessment and Clinical Reasoning


Upon completion of the Doctor of Nursing Practice (DNP) Program students will:

  1. Integrate nursing science, ethics, biophysical, psychosocial, analytical, and organizational sources to provide the highest level of specialty nursing practices.
  2. Develop, implement, and evaluate healthcare practices in healthcare systems that ensure quality improvement and patient safety.
  3. Use analytic methods and evidence based practices to improve practice outcomes and the practice environment.
  4. Implement and evaluate ethical healthcare information systems and patient care technology to improve the quality of patient health outcomes and care systems.
  5. Advocate for healthcare practices that advance social justice, equity, and ethical policies within all healthcare arenas.
  6. Employ interprofessional collaborative teams to improve patient and population health outcomes and healthcare delivery systems.
  7. Lead the integration and institutionalization of (evidence based) clinical prevention and population based health guidelines.
  8. Use clinical judgment, systems thinking, accountability, and specialized knowledge to design, deliver, and evaluate evidence based, culturally proficient care to improve patient, population, and health systems outcomes.




1.  Apply a holistic patient-centered approach to the collection, synthesis, and communication of data gathered, both oral and written. (DNP Essential VIII; NONPF Competencies: Practice Inquiry 1, 2; Ethics 2, 3; Independent Practice 1, 2 4) 

2.  Collect a comprehensive database, including age-appropriate history, physical examination, laboratory and diagnostic studies. (DNP Essential VIII;; NONPF Competencies: Practice Inquiry 2,3; Independent Practice 1,2 3)

3.  Adapt history and physical examination data, and screening according to age, developmental status, culture, language, and patient needs, preferences, and values. (DNP Essential VIII; NONPF Competencies: Practice Inquiry 3; Ethics 2,3; Independent Practice 1, 2, 4, 8)

4.  Formulate a summary of the database including prioritized differential diagnoses and problem list based on interpretation of a comprehensive assessment. (DNP Essential VIII; NONPF Competency: Independent Practice 1, 2, 3, 5, 8)

5.  Construct an organized and complete oral and written summary of the database, including a prioritized differential diagnoses and problem list. (DNP Essential VIII; NONPF Competency: Independent Practice 1, 2, 3, 5, 8)

6.  Formulate prioritized differential diagnoses and problem lists. (DNP Essential VIII; NONPF Competency: Independent Practice 1, 2, 3, 8)

7.  Utilize motivational interviewing skills. (DNP Essential VIII; NONPF Competencies: Ethics 1, 2, 3; Independent Practice 1, 2, 4, 5)



A = 4 points (90-100)
B = 3 points (80-89)
C = 2 points (75-79)
D = 1 point (66-74)
F = 0 points (65 or below)


 DxR Clinician Patient Cases


 SOAP Notes  




 HEB Clinical Skills Lab Focused    

 Patient Encounters: 









 Head-To-Toe Physical Exam




*A cumulative grade of 80% or better is required to pass the course. 


Grading Scale 




Attendance in class is an expectation of each student.


  1. If written assignments are made in a course they are required.
  2. Students are expected to submit written work on the scheduled date and time.
  3. The student must notify the course coordinator prior to the scheduled due date and time if they are unable to submit the written work as scheduled. Failure to make this notification in advance will result in a "zero" for that written work.
  4. If the excuse is accepted as reasonable and necessary, arrangements will be made for an alternative due date and time.
  5. Each student is responsible for making sure that he or she has completed the written work prior to submission.
  6. Late work will be accepted with consequences as outlined per course syllabi.


The APA Publication Manual 7th edition is required for use in all nursing school programs. 


Students are expected to be above reproach in all scholastic activities. Students who engage in scholastic dishonesty are subject to disciplinary penalties, including the possibility of failure in the course and dismissal from the university. "Scholastic dishonesty includes but is not limited to cheating, plagiarism, collusion, and submission for credit of any work or materials that are attributable in whole or in part to another person, taking an examination for another person, any act designed to give unfair advantage to a student or the attempt to commit such acts." Regents Rules and Regulations, Part One, Chapter VI, Section 3, Subsection 3.2, Subdivision 3.22.


Students who are nurses or are preparing to enter the profession of nursing are expected to treat others with respect and compassion. “The principle of respect for persons extends to all individuals with whom the nurse interacts. The nurse maintains compassionate and caring relationships with colleagues and others with a commitment to the fair treatment of individuals, to integrity-preserving compromise and to resolving conflict. This standard of conduct precludes any and all prejudicial actions, any form of harassment or threatening behavior, or disregard for the effects of one’s actions on others” (American Nurses Association Code for Nurses, Interpretive Statement 1.5).

The students, faculty, Department Chairs, Associate Deans, and the Dean of the School of Nursing of the University Texas Health Science Center San Antonio subscribe to the highest standards of conduct. Our aim is professional behavior beyond reproach. Failure to abide by the signed code of professional conduct may lead to suspension and/or permanent dismissal from the UTHSCSA SON. In particular, we subscribe to the provisions of the Code of Ethics for Nurses (http://bit.ly/1mtD5p2) and the following points of conduct.


School of Nursing Netiquette Guidelines for Online Interaction

Netiquette guidelines provide information for behaving properly online, when using email, tweets or texts so that you may successfully communicate your thoughts in a manner that is respectful and avoids misunderstandings with others.


Any student seeking reasonable accommodations through the Americans with Disabilities Act (ADA) should contact either the Associate Dean for Admissions and Student Services within the first week of the semester or schedule a meeting with the UTHSCSA ADA Compliance Office so that appropriate accommodations may be arranged. A request for accommodations (Form ADA-100: http://uthscsa.edu/eeo/form100-Faculty-student-resident.pdf) must be completed and submitted to the Executive Director of the ADA Compliance Office before accommodations can be provided. Additional information can be provided in the Student Success Center, Room 1.118 or through the ADA Compliance Office website: http://uthscsa.edu/eeo/request.asp.


DxR Clinician is a cloud-based, highly interactive application designed for the purpose of helping students master patient assessment and diagnostic-reasoning. The link to register and pay the $75 semester subscription is here:https://dxrgroup.com/product/uthscsahw/   


Bickley, L. (2020). Bates’ Guide to Physical Examination and History Taking. 13th Edition. Philadelphia, PA: Wolters Kluwer. ISBN-13: 9781496398178 


Seller, R.H. & Symons, A.B. (2018). Differential diagnosis of common complaints (7th ed.). St. Louis, MO: Elsevier.  ISBN: 9780323512329 

Required Supplies: 

Purchase a short white lab coat personalized with your name and current degree (i.e. Jane Smith, BSN, RN with the UT Health San Antonio School of Nursing Logo.  Lab coats are available at local uniforms stores. We suggest having the logo placed on the lab coat by Sunshine Medical Uniforms: 7330 Louise Pasteur, San Antonio TX 78229 


Hagan, J.H., Shaw, J.S., & Duncan, P.M. (Eds.) Bright Futures: Guideline Pocket Guide. 4th ed. American Academy of Pediatrics. ISBN-13:  978-1610020824. 


  1. 1. Foundations of Clinical Proficiency, Clinical Reasoning and Recording Findings 

  1. 2. Evaluating Clinical Evidence and Differential Diagnoses 

  1. 3. Health History and Motivational Interviewing 

  1. 4. General Survey 

  1. 5. HEENT 

  1. 6. Dermatology and Lymphatics 

  1. 7. Abdominal and Renal 

  1. 8. Cardiovascular 

  1. 9. Pulmonary 

  1. 10. Musculoskeletal 

  1. 11. Neurology and Mental Health 

  1. 12. Male and Female Genitourinary, Breasts, Rectal 

  1. 13. Special Populations: Pregnancy, Newborn, Pediatrics, Geriatrics 

CALENDAR - 1st Day Only

Please check the schedule for recent updates on Class Dates & Room.

Please read chapters 1-4 in the Bates textbook. The topics we will cover on August 24th from 8 am- 12 pm include the following: 

Clinical proficiency, Clinical Reasoning, Documenting, Differential Diagnoses, Health History, Motivational Interviewing, The General Survey, Vitals & Pain. 
We will also have an orientation to the HEB Clinical Skills Lab and to the DxR Clinician program.  
On behalf of all the faculty, welcome and we look forward to working with you! 
Sarah KnoeckelDNP, APRN, FNP-BC 
NURS 6110 Course Coordinator 

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