Exam 1 Flashcards
1
Q
What is health assessment?
A
systematic method of COLLECTING and ANALYZING data for the purpose of planning patient-centered care.
2
Q
Physical Appearance and Hygiene Components of General Inspection (4)
A
-General Appearance: Any obvious findings like tremors or facial drooping?
-Age: Does the patient appear to be the stated age?
-Skin: What is the color and condition of the patient’s skin? Any variations in color? Any obvious lesions?
-Hygiene: Is the patient clean and well groomed? Any odors?
3
Q
Body Structure and Position Components of General inspection (3)
A
-Stature: What is the patient’s position or posture? Does patient sit or stand straight up?
-Nutritional status: Well-nourished? Thin? Obese?
-Body Symmetry: Right and left sides of body symmetric in size?
4
Q
Body Movement components of General Inspection (3)
A
-Patient’s movement: Does the patient walk or move with ease? Any use of assistive devices?
-Gait: Is the gait balanced and smooth?
-Involuntary movement: Any involuntary movements like tremors or tics?
5
Q
Emotional/Mental Status and Behavior Components of General Inspection (6)
A
-Alert: Is patient alert to person, place, and time (AAO x 3)?
-Eye contact: Does patient maintain eye contact? (some cultural variations, so simply inquire)
-Conversation: Does patient converse appropriately?
-Facial expressions (affect) and body language: Appropriate for the conversation? Any distress?
-Dress/Attire: Is the patient dressed appropriately for the weather?
-Behavior Appropriate?: Is the patient’s behavior appropriate?
6
Q
Questions to assess alertness (3)
A
-Person–Who are you?
-Place–Where are you located?
-Time–What day is it? What month is it?
7
Q
4 components of general inspection
A
Physical appearance and hygiene
Body structure and position
Body Movement
Emotional/mental status
8
Q
What is a health history?
A
information about the patient’s current state of health, current medications, previous illnesses and surgeries, a family history, personal and psychosocial history, and review of systems
9
Q
Components of health assessment
A
Collect health history
Perform physical exam
Document data
Analyze and Interpret Data
Develop care plan
10
Q
Signs
A
objective data observed, felt, heard, or measured.
Ex: rash, enlarged lymph nodes, and swelling of an extremity.
11
Q
Symptoms
A
subjective data perceived and reported by the patient. Ex: pain, itching, and nausea
Primary data: from patient; Secondary data: from family
12
Q
Types of health assessments
A
Comprehensive
Problem-based/focused
Episodic/follow-up
Shift
screening
13
Q
6 vital signs
A
Temperature
Heart Rate
Respiratory rate
Blood pressure
Oxygen Saturation
Pain
14
Q
Context of care
A
circumstances or situations related to health care delivery including setting and environment, nurse expertises, patient’s history
15
Q
3 assessment techniques for physical exam
A
palpation
inspection
ascultation
16
Q
When systolic and diastolic levels fall in different categories, how do you classify blood pressure
A
use the higher CATEGORY NOT the higher number
17
Q
Normal blood pressure range?
A
less than 120/80 mmHg
18
Q
Prehypertension Blood pressure range
A
Systolic: 120-139
Diastolic: 80-89
19
Q
Hypertension Stage I range
A
Hypertension Stage I
Systolic: 140-159
Diastolic: 90-99
20
Q
Hypertension Stage II range
A
Stage II
Systolic: > 160
Diastolic: > 100
21
Q
Problem-based/focused assessment
A
involves a history and physical examination that is limited to a specific problem or complaint (e.g., a sprained ankle). Common in a walk-in clinic or emergency department. Nurse also considers the potential impact of the patient’s underlying health status.
22
Q
Comprehensive assessment
A
detailed history and physical examination performed at the onset of care. It encompasses health problems experienced by the patient; health promotion, disease prevention, and assessment for problems associated with known risk factors; or for age- and gender-specific health problems.
23
Q
Episodic/follow-up assessment
A
usually done when a patient is following up with a health care provider for a previously identified problem.
24
Q
Screening assessment/examination (what is it and where performed)
A
short examination focused on disease detection.
May be performed in a health care provider’s office (as part of a comprehensive examination) or at a health fair.
Ex: include blood pressure screening, glucose screening, cholesterol screening, and colorectal screenings
25
Shift assessment:
during hospitalization, purpose is to identify changes to a patient’s condition from the baseline; thus the focus of the assessment is largely based on the condition or problem the patient is experiencing.
26
Inspection (any equipment?)
Visual and olfactory exam of patient
-pen light
27
tangential lighting
create shadows by directing pen light at a right angle
28
Palpation
feel for texture, size, shape, consistency, pulsation and location of certain parts of a patient’s body
29
Precaution for palpation
Nurse’s touch should be gentle, warm, and nails short. Must state purpose and
need for touch, and manner and location of touch
30
Surfaces of hand best for palpation, vibration, temperature?
palmar surface and finger pads = more sensitive to palpation than fingertips.
ulnar surface of hand extending to fingertip = very sensitive to vibration
dorsal surface of hand (back) = more sensitive to temperature
31
Light palpation (depth and usage)
(approx 1 cm)
should be done PRIOR to deep palpation
Good for
assessing skin, pulsations, and tenderness
32
Deep palpation
approx 4 cm
-used to determine size and contour of an organ
33
Four characteristics of Auscultation
Intensity: loudness of the sound
Pitch: frequency of sounds. (High pitch =breath, low pitch =heart)
Duration: short, medium, or long. Layers of soft tissue can dampen the
duration of sound
Quality: hollow, dull, crackle
34
What is stethoscope good for and why
good for evaluating conditions of heart, blood vessels, lungs, + intestines because uses selective listening and blocks out extra sounds
35
4 things to do before stethoscope usage
-Disinfect stethoscope in between uses
- warm the head of the stethoscope
- remove distractions, quiet room is best for auscultating
-use on bare skin
36
3 Factors that can interfere with accurate auscultation:
-Pt gets cold/shivers + muscles contract and interfere with normal sounds
-Listening over clothing can be less accurate
-Friction of body hair rubbing can sound like abnormal lung sounds/crackles
37
How to perform rectal temp reading?
pt should be in Sim’s position with upper leg flexed. Insert 1-1.5 inches
38
What to know about rectal temp?
most accurate
Not performed often because it is invasive, less comfortable, requires more time, and has an increased risk of an infection compared to the others.
39
Types of Electronic thermometers
(how they work and accuracy of each)
oral, axillary, or rectal temperature. (1 below core temp, 2 below core temp, core temp)
Measures temperature of blood flowing near the tissue
40
What is Tympanic membrane thermometer?
inserted inside the ear, measures temperature of blood flowing near the tympanic membrane
41
Temporal artery thermometer (how it works and when accurate)
Detects heat emitted from pt’s forehead to behind the ear (temporal artery to temporal artery)
High accuracy in children over 2 yr old and adults in critical care
- avoid taking after extreme temps
42
Use of diaphragm vs bell of stethoscope
Diaphragm: large part for high pitch sounds like breath, bowels, normal HR
Bell: small part for low pitch sounds like extra heart and vascular sounds
43
What does automated BP device do?
senses blood flow vibrations and convert into electrical impulses
44
How to choose cuff size? What happens if wrong size?
Ideal cuff bladder: encircle 80% of upper arm
Ideal cuff width = cover 40% of circumference of limb
Cuff too wide = BP underestimated
Cuff too narrow = BP overestimated
45
Pulse oximeter
measures oxygen saturation in arterial blood + pulse rate. Will be accurate for oxygen saturation 70-100%,
46
Where to use pulse oximeter? When is it inaccurate?
-on highly vascular area (digits, ear lobes)
-inaccurate on cold digits or with nail polish
47
How to measure height in adults or older children? What to measure height in?
-Lower height attachment until it is in firm contact with the top of patient’s head (not bent), no shoes, eyes parallel to floor
-Height recorded in feet and inches OR centimeters for children, adolescents, adults
48
Two growth measures
height and weight
49
3 Height Influences
age, genetics, diet
50
How to measure weight?
use platform scale, no shoes, calibrated to 0 before use
- record in kg and pounds for older children and adults
51
What does sudden weight gain and loss indicate?
sudden increase: fluid volume
sudden decrease: disease
52
6 Weight Influences
Diet
Genetics
Age
Exercise
Health conditions
Fluid Volume
53
When is temperature the highest and lowest?
Diurnal variation means lowest in morning, highest in evening
54
How does menstruation and exercise affect body temp?
They increase it
55
What precaution to take for oral temp?
Wait 10 minutes if patient just smoked, had hot or cold liquids
-position under tongue
56
Why is axillary temp inaccurate?
2 degrees less than core b-c no major blood vessels in axillary
also many times it is not directly under arm.
57
Expected temperature ranges for adults (C and F)
from 96.4° to 99.1° F (35.8° to 37.3° C)
with an average of 98.6° F (37° C)
58
What to do with the ear in tympanic membrane temp readings?
tug up for over 3 yrs, tug down for under 3 yrs to straighten ear canal
59
Heart Rate range and average
60-100 beats/min, 70 beats/min
60
How to measure heart rate
1. palpate pulse at the radial, brachial, carotid artery or by auscultating the heart
2. measure number and rhythm
61
How does heart rate measurement differ by rhythm in adults?
if regular rhythm: count 30 secs x2 or 15 secs x4
If irregular rhythm: count full minute. Will be ‘regular irregularity’ or ‘irregular irregularity’
62
5 Respiratory Rate influences
-age
-fear
-anxiety
-exercise
-high altitudes
63
How do men, women, and children breath?
Men and children typically breathe diaphragmatically, while woman breathe thoracically
64
What 4 things to note when measuring respiratory rate?
Amount: ventilatory cycles per minute (measure 30 sec*2)
Depth: described as deep, normal, or shallow
Rhythm described as regular or irregular
Effort: if normal = even, quiet, effortless
65
Adult respiratory rates and oxygen saturation
12-20 breaths/minute
92%
66
What to know about pediatric blood pressure? (2)
-assessed routinely from age 3 and up
-usually lower than adult
67
Pulse pressure
difference between systolic and diastolic
68
Systolic vs Diastolic
systolic = maximum pressure exerted on arteries when ventricles contract or eject blood from heart. (1st korotkoff sound, top)
Diastolic = minimum amt of pressure exerted on vessels, when ventricles relax and fill with blood (5th korotkoff sound, bottom)
69
Direct vs indirect BP measurement
Direct: catheter in artery, reserved for critical care
Indirect: sphygmomanometer and stethoscope
70
Orthostatic hypotension
measure BP at sitting, laying, and standing; drop in BP
as patient goes from lying/sitting to standing
71
When can children use oral temperature?
Age 5 and up
72
Thermometers and findings for children under 5
Recommended route = axillary, tympanic membrane, and temporal artery (most accurate in children); rectal in febrile (1 in)
Finding: 98.6 F/37 C
73
Two reasons for low temperature variations in children
Low temperature from environmental exposure, and inability to regulate as newborns b-c skin thinner
74
3 reasons for high temps in children
High temperature associated with viral/bacterial infections, dehydration, and environmental exposure to heat
75
How to measure heart and respiratory rate for children?
Listen to apical pulse for FULL MINUTE, count respirations for FULL MINUTE with pediatric stethoscope (no palpation!)
Infants+children usually breathe diaphragmatically, observe abdominal movement
76
Expected vs abnormal pediatric HR and RR findings
Expected findings: elevation in HR and RR usually from crying, fever, respiratory distress, dehydration
Abnormal finding: decreased HR, can indicate serious condition
77
How measure infant height?
top of head to feet in supine
measure in inches or cm
78
How to measure infant weight
platform scale, no clothes or diaper
measure in oz or grams
79
Errors leading to false low BP (5)
-Arm ABOVE THE HEART
- Cuff too WIDE
- Not inflating cuff enough
- Deflating cuff too RAPIDLY (< 2-3 mmHg/sec)
- Pressing diaphragm too firmly on brachial artery
80
Errors leading to false-high BP (7)
- Legs crossed
-Arm BELOW THE HEART
- Cuff too NARROW
- Cuff wrapped too LOOSELY/UNEVENLY
- Deflating cuff too SLOWLY (> 2-3 mmHg/sec)
- Reinflating cuff before completely deflating it
- Failing to wait 1-2 minutes before repeating measurement
81
How does age affect BP?
Age: From childhood to adulthood there is a gradual rise.
82
How does Gender affect BP
After puberty, females usually have a lower blood pressure than males; however, after menopause, a woman’s blood pressure may be higher than a man’s.
83
How does pregnancy affect BP?
During pregnancy, diastolic blood pressure may gradually drop slightly during the first two trimesters of pregnancy, but then it typically returns to the prepregnant levels by term.
84
How do Emotions affect BP?
Feeling anxious, angry, or stressed may increase the blood pressure.
85
How do personal habits affect BP?
Ingesting caffeine or smoking a cigarette within 30 minutes before measurement may increase blood pressure.
86
How does Weight affect BP?
Obese patients tend to have higher blood pressures than nonobese patients.
87
How does race affect BP?
The incidence of hypertension is twice as high in African Americans as in whites.
88
Pain
unpleasant sensory and emotional experience with actual or potential tissue damage
-whatever a person says it is
-6th vital sign
89
Pain threshold
point at which stimulus is perceived as painful, does not vary significantly over time
90
Pain tolerance
duration or intensity of pain that a person endures or tolerates before responding outwardly
91
5 influences on pain
culture, expectations of pain, physical illness, emotional health, role behaviors
92
Decreased pain tolerance with: (6)
w/ repeated exposure to pain, fatigue, anger , boredom, sleep deprivation, apprehension
93
Increased pain tolerance with: (6)
↑ w/ alcohol, medication, hypnosis , warmth, distractions , strong faith
94
Pain can effect (4)
perfusion, oxygenation, metabolism, tissue integrity
95
Pain can result in impaired: (6)
elimination, nutrition, sexuality, motion, sleep, development
96
Cognitive and cultural influences on pain perception (3)
-attention individuals give to pain
-expectation/anticipation of pain
-judgment/explanation of pain (decreased tolerance in those who see pain as unexplainable)
97
Cognitive Bias and pain
nurse's attitudes and beliefs on pain can affect how they perceive and respond to pain of others
98
Problem-based vs emotional based coping
problem-based coping: efforts to manage or change stressor; changes in your activity pattern or self-care activities
emotional-based coping: manage your emotional response including social and religious support
99
Best indicator of pain existence and severity
patient self-report
100
Uses of Numeric rating scale (NRS)
-okay in children and adults
-inaccurate in cultures who read vertically or where individuals pick a sacred number
101
Faces Pain Scale Revised (FPS-R)
-okay for adults and ages 6 and up
102
Clinically Aligned Pain Assessment (CAPA)
establishes pain as more than a number. It contains 5 questions examining how the pain affects comfort, functioning, sleep, and patients changes in pain and level of pain control
103
Differences in acute, ischemic, and persistent pain
• Acute pain= sudden onset, short duration
• Ischemic pain = gradual increase in intensity • Persistent pain= > 6 months
104
Symptom Analysis of pain
Onset
Location
Duration
Characteristics
Aggravating and Alleviating Factors
Related Symptoms
Treatment
Severity
105
Referred pain
pain located far from site of pathology
106
Visceral pain and how it presents
Visceral pain = inner organs + blood vessels
Caused by tumor = aching + well localized
Caused by obstruction = intermittent cramping + poorly localized
107
Somatic pain and how it presents
Somatic pain = muscle, bones, soft tissues
Well localized, described as aching or throbbing
108
Related Symptoms of low-to-moderate acute pain
Low-to-moderate acute pain intensity = SNS palpitations, dyspnea, diaphoresis, increase RR
109
Related symptoms of severe/deep pain
PNS pallor, rapid irregular breathing, nausea, vomiting
110
5 steps for patients who cannot communicate
1. Attempt a self-report from pt or explain why self report is not possible
2. Look for potential causes of pain. Ex: pathological conditions, common problems, procedures
3. List patient behaviors that indicate pain
4. Proxy reporting = identifying behaviors that caregivers or others knowledgeable about pt may recognize to indicate pain
5. Administer analgesics that are ordered to examine whether pain is reduced
111
4 abnormal findings during pain when you OBSERVE patient
• Guarding of painful body part
• Rubbing or pressing painful area
• Distorted posture
• Fixed or continuous movement
112
5 abnormal findings during pain when you LISTEN to patient
Moaning, grunting, screaming, crying, gasping
113
Abnormal finding when you MEASURE blood pressure during pain
SNS may increase systolic BP
114
Wong-baker FACES pain scale
okay for ages 3 and up
115
Abnormal finding when you PALPATE pulse during pain.
HR may increase
116
Abnormal finding when you ASSESS respiratory rate and pattern during pain
RR may be slow and deep (relaxation technique) or rapid and shallow
117
Abnormal finding when you INSPECT site for appearance of pain.
Inflamed area, incisions or visible injury
118
Abnormal finding when you PALPATE the site for tenderness
Tissue damage or incision may lead to pain on palpation
119
Pain response in children (neonate, young, school age)
Neonate: global response of ↑ HR and BP; decreased Oxygenation, pallor, sweating
Young children: unable to distinguish pain and anxiety
School children: understand and describe location of pain
120
Pain response in older adults (3)
-perception of pain NO DIFFERENT than that of any other adult (PAIN IS NOT AN EXPECTED PART OF AGING)
-slowed transmission of pain
- Be sure to ask how pain affects function, sleep, appetite , activity, mood , and relationships
121
Reliable pain assessment tools for older adults
Iowa Pain Thermometer (IPT), Faces Pain Scale-revised (FPS-r) and Numeric Rating Scale (NRS)
122
Health promotion
process of enabling people to increase control over and improve their health; dependent on adaptation to change
123
Disease prevention
component of health promotion; behaviors motivated by a desire to avoid illness, detect illness early and manage illness when it occurs
124
What does health promotion encompass?
health, wellness, disease, and illness
125
Illness
Physical manifestations and subjective experiences
(can have illness with no disease)
126
Disease
functional/structural disturbance when person's adaptive mechanism to counteract stimuli and stresses fails
(can have disease with no illness)
127
3 things on Wellness
- positive state of health of an individual, family, or community
-constantly changing
- multidimensional( Physical, mental, spiritual, social, occupational, environmental, intellectual, and financial)
128
Health
State of complete physical, mental, and social well-being; not necessarily an absence of disease
129
US Preventive Services Task Force vs HealthyPeople 2030
US Preventive Services Task Force = Makes recommendations about preventive services, assigns a grade to how beneficial that service will be for the people
HealthyPeople 2030 = sets goals + objectives for people in the U.S.
130
Biggest and second biggest predictor of life expectancy, morbidity, and mortality
-Low SES
-Ethnic and racial minority 2nd biggest predictor
131
Elimination of health disparities focuses on (2)
1. increasing access to health services
2. developing cultural competence
132
Individual assessment for health promotion
comprehensive assessment on health status, behaviors, and risk.(includes family history and personal factors); nurse-pt relationship important, nurse must be sensitive to each person’s goals and values
133
Family Assessment for health promotion
-use a genogram to understand familial risks across generation
Square = male Circle =female Blacked out shape = deceased
-important to understand family dynamics, strengths, and context
134
Community assessment for health promotion
requires participation from community representatives and data collection strategies through observations, interviews, and understanding the structure, makeup of community
135
USPSTF Five levels of recommendation
U.S Prevention services Task Force Recommendation
A : high certainty of substantial net benefit (recommends)
B: high / moderate of moderate net benefit ( recommends)
C: moderate certainty of small net benefit (consider patient preferences/ selective recommendation)
D: harm > benefit; moderate/ high certainty of 0
I: insufficient evidence for or against
136
Four elements of health promotion
optimization of health
evidence
patient/community centered
enculturation
137
Primary Prevention
Combination of strategies aimed at optimizing health and prevention of disease
Ex. health education, immunization, exercise, safe living/work environments, protection from accidents, and effective stress management to prevent disease.
138
Secondary prevention
screening to identify people in early state of disease and cure or limit disability
139
Tertiary Prevention
minimize effects of disease and disability through collaborative disease management; rehabilitative
Can use a lot of primary prevention strategies in tertiary prevention.
Strategies similar but goal differ. Ex: aerobic exercise to maintain health but also for obese patient weight loss
140
Screenings should be: (3)
safe, cost-effective, and make a difference in morbidity/mortality
141
What must screening be to be accurate?
screening must have high degree of RELIABILITY and VALIDITY.
Reliable = same result is achieved when different people perform the test
Validity = ability of test to detect disease, needs to be both sensitive and specific
142
Sensitivity vs specificity
Sensitivity: correctly identify those with condition
Specificity: identify those without condition
143
What 5 factors affect HR?
physical exertion, fever, anxiety, hypotension, hormonal imbalances
144
7 characteristics of physical setting for health history
-private
-quiet
-comfortable room (ideally unoccupied or with curtain closed)
-no environmental distractions
-patient should be comfortable and ideally in street clothes
-nurse and patient alone
-nurse and patient face to face
145
How does age affect patient centered care in health history?
It may influence accuracy, participation, or completeness of data.
Older adults may have decreased ability to participate. Parents often involved for children.
146
How to incorporate culture in patient centered care in health history?
avoid stereotyping and interact with individuals as a unique person
147
How does language affect patient centered care in health history?
limited english proficiency (LEP) may indicate need for certified translator
148
How does physical/emotional distress affect patient centered care in health history?
limit number and nature of questions to only those necessary; save rest for later
-use focused assessment
149
How does hearing impairment affect patient centered care in health history?
speak slowly and clearly, face the individual so they can see your face
150
How does visual impairment affect patient centered care in health history?
provide assistance with written forms
151
How does cognitive impairment affect patient centered care in health history?
secondary sources such as medical POA may be needed; rely more on preestablished health record
152
Gender identity vs gender expression
Gender identity : internal sense of gender; formed by age 3
Gender expression: how individual presents their gender in society
153
2 parts of professional behavior to build rapport
make good first impression with appearance (dressing, hygiene, grooming)
present a caring, confident, warm, professional demeanor
154
7 parts of effective communication to build rapport
-efficient
-calm and unhurried
-actively listen
-understand patient POV
-communicate acceptance and respect
-avoid reactions
-listen first, document 2nd
155
4 keys to a successful patient interview
-good first impression
-be prepared (review any available health data prior to meeting)
-be attentive
-avoid medical jargon
156
What happens in Introduction phase of interview? (4)
-Introduce self and ask patient what they would like to be called
-Describe purpose and process of the interview/encounter
-Prepare patient for what to expect (length of time)
-If other people in room, ask patient for their relationship and if they are okay with the person being present
157
What is purpose of introduction phase of interview?
build rapport
158
What is the single-most important factor for successful interviewing?
the communication skill of the nurse. Nurse should use therapeutic communication
159
What happens in the discussion phase of an interview? (2)
-facilitate and maintain a patient-centered discussion
-use various communication skills and techniques to collect data and enhance conversation
160
What happens in the summary phase of the interview? (5)
-summarize the data with the patient
-allow the patient to clarify data
-create shared understanding of the problems with the patient
-plan for next steps and end interview
-emphasize data that have implications for health promotion, disease prevention.
161
Behaviors to avoid in interview (5)
• using medical terminology
• Asking why
• value judgements
• being authoritarian or paternalistic
• interrupting patient ( or changing subject )
162
Types of interview questions and their purpose
Open- ended : broad, encourages free flowing open response
Directive: closed -ended, allow patient to focus on set of thoughts (must use with open-ended to allow patient to use their own words to avoid inaccurate conclusions)
163
What is the purpose of Permission giving?
helps patients feel that it is safe to discuss such topics.
Ex: Many people your age have questions about sex. What questions or concerns do you have?
164
8 things on the art of asking questions
- define words as needed and avoid technical terms
- encourage specificity
- adapt questions to patient's developmental level, knowledge and understanding
- ask one question at a time
- be attentive to feelings (certain emotional responses may mean more info needed)
- prefix sensitive questions by letting patient know you are required to ask or use permission- giving )
- if patient has questions, you can answer or gather more info to give additional resources
-Avoid giving in-depth answers or providing more information than necessary
165
When is comprehensive health history done?
- generally for new patients in all settings; postponefor unstable patients
-taken during admission or when pt's reason for seeking care is to relieve generalized symptoms
166
When is episodic/follow- up health history done?
-specific problem or problems for which pt is already been receiving treatment
-Focus on changes that have taken place since the last visit
-Disease management or health promotion (Early detection of complications or decline in health)
167
How does problem-focused health history look different?
data limited to specific problem, but detailed enough so related data collected particularly data that may affect presented problem
168
How to handle personal questions during interview?
use brief, direct answers
You can share supportive personal experiences
169
How to handle silence during interview?
be comfortable with it; it may indicate patient is thinking or patient is not ready to discuss that topic
170
How to deal with others in room while doing interview?
learn their relationship with the patient and get patient's permission for their presence
If they are disruptive/ speak for the patient, ask them to stop or to leave
If they are disruptive children, give them a distraction
171
How to deal with a talkative patient?
redirect conversation if needed with closed-ended questions
172
How to deal with crying patient?
offer tissue and let patient know it is acceptable
173
How to deal with angry patient?
identify the source of anger
If pt angry w/ someone else, discuss w/ pt on how to approach that person
If pt angry with nurse, encourage them to discuss feelings. If not resolved, may need to switch out nurses
174
What is interpretation?
when nurses share w/ pt the conclusions they have drawn from the data pt has given to nurse
Ex: let me share my thoughts on what you have said..you said xyz, I wonder if xyz is contributing to
175
What is summarization?
nurse condenses and chronologically orders data; useful for patients who ramble
176
What is confrontation?
asking patients about inconsistencies between patient's reports and your observations; use a confused or misunderstanding tone rather than an accusatory or angry one
177
What is reflection?
gain clarification by restating a phrase used by pt in the form of a question.
Ex: Pt: I just didn't feel right. Nurse: you didn't feel right? Pt: Uh huh, I was dizzy
178
What is clarification?
Obtaining more information on conflicting, vague, or ambiguous information
179
What is facilitation?
use phrases to encourage patient to continue talking
ex: go on, uh huh,
180
What is active listening?
listening with a purpose to the spoken words as well as noticing nonverbal behaviors.
181
What is included in biographic data (10)? When is it gotten and when is it updated?
collected first visit and updated as changes occur
-Name, preferred name
- gender, gender identity
- race / ethnicity
- birthdate, place
- address, phone# , email address
- contact person
- religion
- marital
- source of data
- occupation
182
How to recognize potential victim of human trafficking or IPV?
They are unable to speak, nervous, or have someone else speak for them
183
chief complaint/concern
Patient's reason for seeking care, presenting problem
-often recorded in direct quotes
- if more than one problem, have pt list all and prioritize problems
184
History of presenting illness
same as symptom analysis; you can use OLDCARTS
-unnecessary for well visits
185
3 components of Present health status (and their components)
-Current health conditions (diagnosis length, impact of illness on ADLs)
-Medications (all kinds, dose/frequency, perception of effectiveness, reason for medication)
-Allergies ( get symptoms to determine if allergy or adverse effect)
186
Gravidity vs pavity
Gravidity: number of pregnancies
Pavity: number of births
187
7 Components of Past Health History (and their related bits)
- Childhood illnesses
- Surgeries (type, date, outcome)
- hospitalizations (illness, date, outcome)
- Accidents / injuries (type, date, outcome)
- Immunizations
- last examination ( type , date , outcome )
- Obstetric history (gravidity, parity, # of abortions/miscarriages
188
3 things to know for family history collection
-identify illnesses of genetic, familial, or environmental nature (include blood relatives, spouse, children)
-use genogram or patient narrative
-go back 3 generations
189
8 Components of personal and psychosocial history
- Personal status
- Family and social relationships
- diet/nutrition
- functional ability
- environment
- mental health
- health promotion
- drug use
190
How to gather personal status?
-get general statement on self-esteem
-examine culture, religion, education, work satisfaction, hobbies, interests,
191
How to gather family and social relationships? (3)
-note general satisfaction and thoughts on these relationships
-note health of family and friends
-be aware of IPV and ask about abuse
192
How to gather diet and nutrition?
Ask about likes and dislikes, food tolerance, eating habits, dietary restrictions, recent appetite or diet changes
Ask about overeating, sporadic eating
193
How to gather functional ability?
perceived ability to complete ADLs
194
How to gather mental health?
Ask about personal stress and sources, anxiety, nervousness, depression, irritability, anger
195
How to gather environment? (3)
Ask about safety in home and neighborhood
Ask about transportation
Ask about international travel
196
How to gather health promotion activities
Ask about sleep habits, exercise, routine health exams, safety practices, stress management
197
How to gather drug use? Tobacco? Alcohol? Illicit?
identify substance used, amount used, duration of habit
Tobacco: record history in pack-years (cigarettes). Number of packs smoked per day multiplied by number of year smoked
Alcohol: type, amount, frequency, any high risk behaviors
Illicit drug: ask about high risk behaviors such as sharing needles and driving under the influence of drugs
198
What illicit drugs should you ask about?
Ask about marijuana, cocaine, crack cocaine, bariturates, amphetamines
199
What is the purpose of review of systems? What else to know about it?
-to make sure nothing is missed
-conducted to inquire about the past and present health of each of the patient’s body systems. You should conduct symptom analysis if info identified
-no need to recollect data for a system already discussed in previous sections
-use medical terms in documentation
200
How do present health status differ in older adults
- often have many medication, so ask about allergies, adverse effects/ and access to medications)
- ask about any recent immunizations
201
How to enhance health history for older adults? (3)
- seek info directly from patient before allowing report from 3rd party
-maintain eye contact so patient can see mouth
-Make more time to interact with them. Will have multiple symptoms, conditions, medications, and long past health history
202
How does past health history and family history differ in older adults?
-memory may affect accuracy of past health history
-questionable value of family history question
203
How does personal status differ in older adults?
Ask about changes in role/perception in retirement, income changes, current living arrangements and satisfaction with those arrangements
204
How do family and social relationship questions differ in older adults?
Ask about participation and access to family and friends activities; pets, familial conflict
205
How does diet/nutrition differ in older adults?
They have decreased appetite, saliva, and chewing
Use Mini Nutritional Assessment -Short Form (MNA-SF) - six questions on food intake, weight loss, mobility, psychological stress, acute disease, dementia, depression
206
How is functional ability questioned in older adults?
independent, partially independent, or dependent)
ability to perform ADLs and IADLs i. e shopping, meal prep / finance management
207
How is mental health questioned in older adults? What is typical? What is atypical?
-determine circumstances to distinguish from pathologic
• increases in sadness, grief, response to loss, temporary "blue" moods are typical and expected
- Anxiety is rational within reason (prolonged, exaggerated, or anxiety that interferes w/ function is not normal and is often attributed to physical illness
- Depression= often overlooked but key to suicide prevention *white men > 65 yrs have ↑ risk of suicide
208
How is sleep questioned in older adults? Why is it included?
- ask about bedtime rituals, sleep quality
-poor sleep can increase prevalence of other problems (poor sleep is not a normal part of aging process!)
209
How is alcohol use questioned in older adults?
type, amount, frequency
-tolerance decreases with age so effects felt quicker and longer
210
How is environment questioned in older adults?
-asked about hazards in home and neighborhood
Do you have stairs? Do you feel safe? Do you have any tripping hazards, loose rugs, smoke detectors, cords
211
How does pediatric health history differ?
-observe parent-child interactions (allow child participation as age appropriate)
-Adolescents should have chance to talk w/ nurse alone ( legal right in most states)
212
What is added to pediatric biographic data?
name of informant and relationship to child
-any child nicknames
213
How is chief complaint questioned in pediatrics?
-recorded in words of parent or child
If for well-child visit, say which well-child visit
If for acute/ chronic illness, brief sentence on symptoms
214
What to add to pediatric symptom analysis?
sleep, eating, and elimination patterns which can offer clues on severity
215
How is family history questioned in pediatrics?
-still 3 generations including siblings
-pay attention to congenital issues, infants and child deaths
- note any substance use
216
How is personal status questioned in pediatrics? (3)
-current level of functioning
- ask parent to describe personality and temperament (include children over 6 in conversation)
- ask about school performance, behavior patterns, unusual behaviors
217
How does past health history differ for pediatrics? (3)
- include Perinatal history for children under 2 and children with congenital, birth or pregnancy complications
-include developmental history (age in which developmental milestones were reached)
-check immunization history at every visit
218
What does perinatal history include?
prenatal care, maternal care, labor and delivery, newborn course
219
How does Family and social questioning differ in pediatrics? (4)
- Composition (any recent changes, pets, important family members )
- Family life (activities, culture, parenting style, discipline methods & effectiveness, childcare / Family dynamics )
- SES ( income sources, government assistance)
-Friends (relationships with those their age including bullying, fighting)
220
How to ask about pediatric home environment?
Ask about facilities, home safety, community, employment (for teens)
221
How to ask about pediatric development?
-use corrected age for premature children until age 3
- assess developmental milestones, school performance, future plans for adolescents
222
How to assess diet and nutrition in pediatrics? (3)
-note diet restrictions associated with nutritional deficiencies or dental caries
*excess juice, junk, low calcium or iron
-For newborns, note formula amount, type, frequency; age of solid food intro
-For adolescents, ask about weight perceptions and behaviors to evaluate for eating disorders, extreme diets, or laxative use
223
How to assess sleep in pediatrics?
note where, with who, amount, and ease of staying and falling asleep
-for newborns, note position and environment
224
How to address pediatric mental health? (4)
-mostly addressed in past health history and social history
• identify current stresses ; identify signs and symptoms of mental illness
• ask about child's coping ability ( any trusted adults? )
-Use Pediatric Symptom Checklist(PSC) for ages 4 and up; parents note behavioral and emotional issues
* PSC Youth report can be used for adolescents to self- report
225
How to assess sexuality in pediatrics? (5)
-ask about puberty
-For girls, ask about age of menarche, menstruation, last menstrual period, frequency and duration
-For boys, ask about testicular changes, self-examination
- evaluate sexually active for pregnancy, STIs , and consensual relations (evaluate sex trafficking)
- gender identity ( gender dysphoria ↑ risk of bullying and mental health problems
